Evidence map›Paper›PMID 33041850›Full record

ArticleFrontiers in physiology2020

Caroline H Roney, Marianne L Beach, Arihant M Mehta, Iain Sim, Cesare Corrado, Rokas Bendikas, Jose A Solis-Lemus, Orod Razeghi, John Whitaker, Louisa O'Neill and 5 more

Open access · goldAbstract read
In one paragraph

Article in Frontiers in physiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 42 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
42citing papers in PubMed, 1 pooled it
6.1field-weighted citation impact, top 2% 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

42 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Article
  5. Article
  6. Article
  7. Ablation of atrial fibrillation sources identified through sequential high-density mapping: in silico comparison against anatomy-based approaches.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
    Article
  8. Automated generation of ablation lesion masks: a unison of electro and optic flow mapping for persistent AF virtual cohorts.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
    Article
  9. Article
  10. Article
  11. Review
  12. Review
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Article
  19. In Silico TRials guide optimal stratification of ATrIal FIbrillation patients to Catheter Ablation and pharmacological medicaTION: the i-STRATIFICATION study.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 · 2024
    Article
  20. Digital twins in medicine.Nature computational science · 2024
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

15 authors at 3 institutions in 3 countries.

Caroline H RoneySchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Marianne L BeachSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Arihant M MehtaSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Iain SimSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Cesare CorradoSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Rokas BendikasSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Jose A Solis-LemusSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Orod RazeghiSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
John WhitakerSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Louisa O'NeillSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Gernot PlankDepartment of Biophysics, Medical University of Graz, Graz, Austria.
Edward VigmondIHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.
Steven E WilliamsSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Mark D O'NeillSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Steven A NiedererSchool of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
King's College London · GBElectrophysiology and Heart Modeling Institute · FRMedical University of Graz · AT

Funding

British Heart Foundation FS/20/26/34952British Heart Foundation PG/13/37/30280British Heart Foundation PG/15/91/31812Medical Research Council MR/S015086/1Wellcome Trust
6 · The paper itself

Abstract

Catheter ablation therapy for persistent atrial fibrillation (AF) typically includes pulmonary vein isolation (PVI) and may include additional ablation lesions that target patient-specific anatomical, electrical, or structural features. Clinical centers employ different ablation strategies, which use imaging data together with electroanatomic mapping data, depending on data availability. The aim of this study was to compare ablation techniques across a virtual cohort of AF patients. We constructed 20 paroxysmal and 30 persistent AF patient-specific left atrial (LA) bilayer models incorporating fibrotic remodeling from late-gadolinium enhancement (LGE) MRI scans. AF was simulated and post-processed using phase mapping to determine electrical driver locations over 15 s. Six different ablation approaches were tested: (i) PVI alone, modeled as wide-area encirclement of the pulmonary veins; PVI together with: (ii) roof and inferior lines to model posterior wall box isolation; (iii) isolating the largest fibrotic area (identified by LGE-MRI); (iv) isolating all fibrotic areas; (v) isolating the largest driver hotspot region [identified as high simulated phase singularity (PS) density]; and (vi) isolating all driver hotspot regions. Ablation efficacy was assessed to predict optimal ablation therapies for individual patients. We subsequently trained a random forest classifier to predict ablation response using (a) imaging metrics alone, (b) imaging and electrical metrics, or (c) imaging, electrical, and ablation lesion metrics. The optimal ablation approach resulting in termination, or if not possible atrial tachycardia (AT), varied among the virtual patient cohort: (i) 20% PVI alone, (ii) 6% box ablation, (iii) 2% largest fibrosis area, (iv) 4% all fibrosis areas, (v) 2% largest driver hotspot, and (vi) 46% all driver hotspots. Around 20% of cases remained in AF for all ablation strategies. The addition of patient-specific and ablation pattern specific lesion metrics to the trained random forest classifier improved predictive capability from an accuracy of 0.73 to 0.83. The trained classifier results demonstrate that the surface areas of pre-ablation driver regions and of fibrotic tissue not isolated by the proposed ablation strategy are both important for predicting ablation outcome. Overall, our study demonstrates the need to select the optimal ablation strategy for each patient. It suggests that both patient-specific fibrosis properties and driver locations are important for planning ablation approaches, and the distribution of lesions is important for predicting an acute response.

Indexed as

atrial fibrillationatrial fibrosiscatheter ablationphase singularity mappingvirtual cohort

Identifiers

PMID33041850
PMCPMC7526475
OpenAlexW3086473451

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.