2023-08-14 14:45:12
A new technique improves diagnostic accuracy and personalized therapy for a common arrhythmia.
Multidisciplinary work led by the National Center for Cardiovascular Research (CNIC) in Spain has enabled the development of a new way of evaluating the structural and electrophysiological changes that occur in the heart, specifically atrial remodeling, in patients with a type of arrhythmia very common: atrial fibrillation. This new diagnostic approach is based on the simultaneous evaluation of the electrical and mechanical (contractile) activity of the atria during atrial fibrillation.
To date, points out the main researcher of the study, David Filgueiras, “this had been an unresolved challenge”, since, on the one hand, “the available technology did not allow the integration of both types of information to obtain a marker that would provide an evaluation more complete”, and on the other, “during atrial fibrillation the contraction movements of the heart’s atria are of low intensity and their characterization is a technological challenge”.
Atrial fibrillation is an irregular and often very fast heart rhythm that can lead to blood clots in the heart, increasing the risk of stroke, heart failure, and other heart-related complications.
Nowadays, the classification of patients with atrial fibrillation is fundamentally based on temporal criteria based on the time that the patient has had the arrhythmia. However, explains David Filgueiras, head of the Advanced Development Group on Mechanisms and Therapies of Arrhythmias at the CNIC and cardiologist at the Health Research Institute of the San Carlos Clinical Hospital (IdISSC), “this temporal classification does not allow us to determine the degree of underlying remodeling of a specific patient, which is especially important in the first months of evolution of atrial fibrillation when the degree of advancement of the underlying pathological processes can follow different rates of progression”.
For Filgueiras, “the relevance of this new diagnostic approach is revealed in its ability to make a personalized assessment of the degree of progress of atrial remodeling in a specific patient, beyond the clinical classification based on time criteria.”
Research team members. (Photo: CNIC)
Daniel Enríquez Vázquez, from the Complejo Hospitalario Universitario de A Coruña and member of the CIBERCV, together with the other two first signatories of the work, Jorge G. Quintanilla and Alba García Escolano, from the CNIC, highlight that “at a clinical level, the results of the work indicate that the identification of electromechanical dissociation in patients with atrial fibrillation informs us of a further progression of the disease and the need to make faster decisions to effectively and durably restore normal heart rhythm to these patients”.
The team led by Filgueiras, in collaboration with national and international researchers from the Hospital Clínico San Carlos, Hospital Universitario Central de Asturias, Hospital de la Santa Creu i Sant Pau, the University Hospital Complex of A Coruña, Complutense University of Madrid, Polytechnic University of Madrid, the Autonomous University of Barcelona, the University of Connecticut (United States) and CIBERCV, have worked over the last 10 years to integrate electrical and mechanical information, thus allowing a personalized characterization of the stage of pathological changes associated with progression of atrial fibrillation.
This has been possible thanks to the collaboration of a multidisciplinary team.
In the first phase, clinicians, engineers, and physicists devised the most appropriate strategy to integrate both types of information. The solution was obtained by integrating the tissue Doppler image signal of the atria -a non-invasive test that allows obtaining signals related to tissue displacement- to assess mechanical activity, with the surface electrocardiogram signal, to assess electrical activity.
Both types of information are obtained non-invasively and can be recorded during a transthoracic echocardiography study -a test that studies the shape and function of the heart and part of its internal structures-, which facilitates its implementation in the clinical setting.
A second phase with researchers from the fields of biology, biotechnology, biochemistry and biomedical engineering, together with the CNIC proteomics unit and clinical cardiologists, allowed experimental studies to be carried out to correlate the type of information obtained with this new approach and the changes underlying pathologies in atrial tissue as atrial fibrillation progresses over time.
In addition, new advanced mapping techniques and computational simulations were developed to understand the mechanisms underlying the electrical and mechanical remodeling process during the temporal progression of atrial fibrillation. Finally, the work included a multicenter prospective study in 83 patients recruited during early stages of evolution of atrial fibrillation, with the aim of determining the prognostic value of electrical and mechanical evaluation of the atria in patients with this type of arrhythmia.
The experimental and clinical findings made it possible to observe that in the early stages of evolution of atrial fibrillation an imbalance develops between the electrical activations and the mechanical (contractile) activations of the heart’s atria, in such a way that both parameters are dissociated and the contractile firing frequency is unable to follow electrical activity, in what researchers define as atrial electromechanical dissociation.
The development of this dissociation is a process with a specific evolution over time for each person, although in the vast majority of cases it occurs in the first 2-3 months after the onset of episodes of atrial fibrillation that have not been interrupted.
In addition, the identification of atrial electromechanical dissociation occurs before other remodeling parameters have become apparent and therefore go undetected during routine clinical evaluation or with conventional tools. Thus, Filgueiras emphasizes, “the use of this new diagnostic approach allows early characterization of the degree of underlying remodeling in patients with atrial fibrillation.”
“The study demonstrates that it is possible to integrate electrical and mechanical information from the atria of patients with atrial fibrillation and thus obtain personalized prognostic information regarding the clinical evolution of the arrhythmia,” says Filgueiras.
In addition, Nicasio Pérez Castellano, from the IdISSC, and David Calvo Cuervo, from the Hospital Central de Asturias and currently also a member of the IdISSC, highlight, “the proposed approach and results obtained are reinforced by the non-invasive nature of this new diagnostic approach in the management of patients with atrial fibrillation.
Adds Julián Pérez Villacastín, clinical collaborator of the study at the San Carlos Clinical Hospital and current president of the Spanish Society of Cardiology, that “the development of this type of research and its clinical implementation will allow an increasingly personalized approach to patients with atrial fibrillation”. This is especially relevant in the current context of increasing numbers of patients with atrial fibrillation, which in Spain already affects more than 700,000 people and in Europe exceeds 10 million diagnosed patients.
El estudio se titula “Non-invasive electromechanical assessment during atrial fibrillation identifies underlying atrial myopathy alterations with early prognostic value”. Y se ha publicado en la revista académica Nature Communications. (Fuente: CNIC)
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