109367 20231006143302.0 doi 10.3389/fphys.2021.674197 sideral 125403 ART-2021-125403 eng Celotto, Chiara Universidad de Zaragoza Location of parasympathetic innervation regions from electrograms to guide atrial fibrillation ablation therapy: an in silico modeling study 2021 Access copy available to the general public Unrestricted The autonomic nervous system (ANS) plays an essential role in the generation and maintenance of cardiac arrhythmias. The cardiac ANS can be divided into its extrinsic and intrinsic components, with the latter being organized in an epicardial neural network of interconnecting axons and clusters of autonomic ganglia called ganglionated plexi (GPs). GP ablation has been associated with a decreased risk of atrial fibrillation (AF) recurrence, but the accurate location of GPs is required for ablation to be effective. Although GP stimulation triggers both sympathetic and parasympathetic ANS branches, a predominance of parasympathetic activity has been shown. This study aims was to develop a method to locate atrial parasympathetic innervation sites based on measurements from a grid of electrograms (EGMs). Electrophysiological models representative of non-AF, paroxysmal AF (PxAF), and persistent AF (PsAF) tissues were developed. Parasympathetic effects were modeled by increasing the concentration of the neurotransmitter acetylcholine (ACh) in randomly distributed circles across the tissue. Different circle sizes of ACh and fibrosis geometries were considered, accounting for both uniform diffuse and non-uniform diffuse fibrosis. Computational simulations were performed, from which unipolar EGMs were computed in a 16 × 1 6 electrode mesh. Different distances of the electrodes to the tissue (0.5, 1, and 2 mm) and noise levels with signal-to-noise ratio (SNR) values of 0, 5, 10, 15, and 20 dB were tested. The amplitude of the atrial EGM repolarization wave was found to be representative of the presence or absence of ACh release sites, with larger positive amplitudes indicating that the electrode was placed over an ACh region. Statistical analysis was performed to identify the optimal thresholds for the identification of ACh sites. In all non-AF, PxAF, and PsAF tissues, the repolarization amplitude rendered successful identification. The algorithm performed better in the absence of fibrosis or when fibrosis was uniformly diffuse, with a mean accuracy of 0.94 in contrast with a mean accuracy of 0.89 for non-uniform diffuse fibrotic cases. The algorithm was robust against noise and worked for the tested ranges of electrode-to-tissue distance. In conclusion, the results from this study support the feasibility to locate atrial parasympathetic innervation sites from the amplitude of repolarization wave. info:eu-repo/grantAgreement/ES/DGA-FEDER/T39-17R-BSICoS info:eu-repo/grantAgreement/EC/H2020/638284/EU/Is your heart aging well? A systems biology approach to characterize cardiac aging from the cell to the body surface/MODELAGE This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 638284-MODELAGE info:eu-repo/grantAgreement/EC/H2020/766082/EU/MultidisciplinarY training network for ATrial fibRillation monItoring, treAtment and progression/MY-ATRIA This project has received funding from the European Union’s Horizon 2020 research and innovation program under grant agreement No H2020 766082-MY-ATRIA info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-104881RB-I00 info:eu-repo/grantAgreement/ES/MICINN-FEDER/PID2019-105674RB-I00 info:eu-repo/semantics/openAccess by http://creativecommons.org/licenses/by/3.0/es/ 4.755 2021 PHYSIOLOGY 20 / 81 = 0.247 2021 Q1 T1 1.126 2021 Physiology (medical) 2021 Q1 Physiology 2021 Q1 6.6 2021 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion Sánchez, Carlos Universidad de Zaragoza (orcid)0000-0003-4273-5403 Mountris, Konstantinos A. Universidad de Zaragoza (orcid)0000-0003-2946-3044 Laguna, Pablo Universidad de Zaragoza (orcid)0000-0003-3434-9254 Pueyo, Esther Universidad de Zaragoza (orcid)0000-0002-1960-407X 5007 520 Universidad de Zaragoza Dpto. Informát.Ingenie.Sistms. Área Ingen.Sistemas y Automát. 5008 800 Universidad de Zaragoza Dpto. Ingeniería Electrón.Com. Área Teoría Señal y Comunicac. 12 (2021), 674197 [20 pp.] Front. physiol. Frontiers in physiology 1664-042X 12206654 http://zaguan.unizar.es/record/109367/files/texto_completo.pdf Versión publicada 2203338 http://zaguan.unizar.es/record/109367/files/texto_completo.jpg?subformat=icon icon Versión publicada oai:zaguan.unizar.es:109367 articulos driver 2023-10-06-14:07:16 ARTICLE