Evidence map›Paper›PMID 27056895›Full record

ArticleCardiovascular research2016

Patient-derived models link re-entrant driver localization in atrial fibrillation to fibrosis spatial pattern.

Sohail Zahid, Hubert Cochet, Patrick M Boyle, Erica L Schwarz, Kaitlyn N Whyte, Edward J Vigmond, Rémi Dubois, Mélèze Hocini, Michel Haïssaguerre, Pierre Jaïs and 1 more

Open access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Cardiovascular research, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 192 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
192citing papers in PubMed, 1 pooled it
22.0field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

192 citing papers in PubMed, 1 synthesis or guideline pooled it, 296 citations in OpenAlex.

  1. Pooled it
  2. Women with persistent atrial fibrillation need more than pulmonary vein isolation: personalised extra-pulmonary vein ablation strategy vs. pulmonary vein isolation alone in the TAILORED-AF trial.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2025
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  12. Relationships between three-dimensional fibrosis distribution, atrial adiposity, and voltage abnormalities associated with persistent atrial fibrillation.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2026
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132 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 2 countries.

Sohail ZahidInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
Hubert CochetIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France.
Patrick M BoyleInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
Erica L SchwarzInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
Kaitlyn N WhyteInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
Edward J VigmondIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France.
Rémi DuboisIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France.
Mélèze HociniIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France.
Michel HaïssaguerreIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France.
Pierre JaïsIHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Université de Bordeaux, Bordeaux, France.
Natalia A TrayanovaInstitute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA ntrayanova@jhu.edu.
Johns Hopkins University · USUniversité de Bordeaux · FRInserm · FR

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

aimsThe mechanisms underlying persistent atrial fibrillation (AF) in patients with atrial fibrosis are poorly understood. The goal of this study was to use patient-derived atrial models to test the hypothesis that AF re-entrant drivers (RDs) persist only in regions with specific fibrosis patterns. METHODS AND

resultsTwenty patients with persistent AF (PsAF) underwent late gadolinium-enhanced MRI to detect the presence of atrial fibrosis. Segmented images were used to construct personalized 3D models of the fibrotic atria with biophysically realistic atrial electrophysiology. In each model, rapid pacing was applied to induce AF. AF dynamics were analysed and RDs were identified using phase mapping. Fibrosis patterns in RD regions were characterized by computing maps of fibrosis density (FD) and entropy (FE). AF was inducible in 13/20 models and perpetuated by few RDs (2.7 ± 1.5) that were spatially confined (trajectory of phase singularities: 7.6 ± 2.3 mm). Compared with the remaining atrial tissue, regions where RDs persisted had higher FE (IQR: 0.42-0.60 vs. 0.00-0.40, P < 0.05) and FD (IQR: 0.59-0.77 vs. 0.00-0.33, P < 0.05). Machine learning classified RD and non-RD regions based on FD and FE and identified a subset of fibrotic boundary zones present in 13.8 ± 4.9% of atrial tissue where 83.5 ± 2.4% of all RD phase singularities were located.

conclusionPatient-derived models demonstrate that AF in fibrotic substrates is perpetuated by RDs persisting in fibrosis boundary zones characterized by specific regional fibrosis metrics (high FE and FD). These results provide new insights into the mechanisms that sustain PsAF and could pave the way for personalized, MRI-based management of PsAF.

Indexed as

Atrial RemodelingComputer SimulationModels, CardiovascularAction PotentialsAdultAtrial FibrillationCardiac-Gated Imaging TechniquesCardiac Pacing, ArtificialElectrocardiographyElectrophysiologic Techniques, CardiacFemaleFibrosisHeart AtriaHeart RateHumansImage Interpretation, Computer-AssistedComputational modellingFibrosisPatient-derived atrial modelsPersistent atrial fibrillationRe-entrant drivers

Identifiers

PMID27056895
PMCPMC4872878
OpenAlexW2342217327

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.