New technique to improve diagnosis and personalized therapy for a common cardiac arrhythmia

Multidisciplinary work led by the National Center for Cardiovascular Research (CNIC) has enabled the development of a new approach to assessing the structural and electrophysiological changes that occur in the heart revised headsetof patients with a very common type of arrhythmia: atrial fibrillation.

This new diagnostic approach is based on the simultaneous evaluation of the electrical and mechanical (contractile) activity of the atria in atrial fibrillation. The study is published in the journal nature communication.

The new diagnostic approach is based on the simultaneous evaluation of the electrical and mechanical (contractile) activity of the atria in atrial fibrillation.

According to the chief investigator David Filgueirasuntil now “this has been an unresolved challenge” since “the available technology did not allow the integration of both types of information to obtain a marker that would allow a more complete evaluation” and “in atrial fibrillation the contractile movements of the atria of the heart exhibit a low intensity and characterizing it poses a technological challenge.”

The atrial fibrillation This 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 basically based on temporal criteria, based on the time the patient had the arrhythmia.

However, explains Filgueiras, head of the Advanced Development Group on Mechanisms and Therapies of Arrhythmias at CNIC and cardiologist at the Health Research Institute of the Hospital Clínico San Carlos (IdISSC), “this temporal classification does not allow us to determine the degree of arrhythmias.” In particular the underlying remodeling of a patient, which is particularly important in the early months of the development of atrial fibrillation, when the degree of progression of the underlying pathological processes may follow different rates of progression.”

For the researcher, “The relevance of this new diagnostic approach is demonstrated by its ability to make a personalized assessment of the degree of progress.” revised headset in a given patient, beyond clinical classification based on a temporal criterion”.

Schematic representation of the course of the electromechanical remodeling of the atria of the heart in atrial fibrillation and its prognostic implications. / CNIC

Daniel Enriquez Vázquezfrom the University Hospital complex of A Coruña and member of CIBERCV, along with the other two initial signatories of the paper, Jorge G. Quintanilla and Alba García Escolanofrom the CNIC, emphasize that “at the clinical level, the results of the work suggest that the identification of electromechanical dissociation in patients with atrial fibrillation informs us of greater disease progression and the need to make more rapid decisions in order to return effectively and successfully. “ These patients are able to maintain a permanently normal heart rhythm.”

Recognition of electromechanical dissociation provides evidence of further disease progression and the need to make quick decisions to restore the patient’s normal heart rhythm

The team led by Filgueiras collaborates with national and international researchers from the Hospital Clínico San Carlos, the Hospital Universitario Central de Asturias, the Hospital de la Santa Creu i Sant Pau, the University Hospital of A Coruña, the Complutense University of Madrid and the Polytechnic University of Madrid , the Autonomous University of Barcelona, ​​​​the University of Connecticut (USA) and CIBERCV, has recently worked ten years In this way, electrical and mechanical information can be integrated, allowing for personalized characterization of the stage of pathological changes associated with the progression of atrial fibrillation.

Multidisciplinary collaboration in several phases

In the first phase, clinicians, engineers and physicists developed the most appropriate strategy to integrate both types of information. The solution was obtained by integrating the Tissue Doppler imaging signal of the atria -a non-invasive test that allows to obtain signals related to tissue displacements – to assess mechanical activity with the electrocardiogram signal the surface to evaluate electrical activity.

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Both types of information are obtained non-invasively and can be recorded during a transthoracic echocardiography study – a test that examines the shape and function of the heart and part of its internal structures – making it easier to implement in the clinical setting.

A second phase involving researchers from the fields of biology, biotechnology, biochemistry and biomedical engineering, as well as the CNIC proteomics department and clinical cardiologists, enabled the implementation of Experimental Studies to correlate the nature of the information obtained with this new approach and the underlying pathologic changes in atrial tissue over time as atrial fibrillation progresses.

Also new advanced mapping techniques and simulations Computational techniques to understand the mechanisms underlying the electrical and mechanical remodeling process during the temporal progression of atrial fibrillation.

Finally, the work included a prospective study multicentric in 83 patients Recruited at the early stages of the development of atrial fibrillation with the aim of determining the prognostic value of electrical and mechanical assessment of the atria in patients with this type of arrhythmia.

Atrial Electromechanical Dissociation

The experimental and clinical findings made it possible to observe that in the early stages of the development of atrial fibrillation, an imbalance arises between the electrical activations and the mechanical (contractile) activations of the heart atria, so both parameters are dissociated and the contractile firing frequency is not able to follow electrical activity, which researchers define as atrial electromechanical dissociation.

The results allowed us to observe that in the early stages of atrial fibrillation development, there is an imbalance between the electrical and mechanical activations of the atria.

The development of this dissociation is a process with a specific time evolution for each person, although in the vast majority of cases it occurs within the first 2-3 months after the onset of uninterrupted episodes of atrial fibrillation.

Furthermore, the identification of atrial electromechanical dissociation occurs before other remodeling parameters have become apparent and therefore go undetected by routine clinical evaluation or by conventional instruments.

Therefore, Filgueiras emphasizes: “The use of this new diagnostic approach allows for an early characterization of the extent of the underlying remodeling in patients with atrial fibrillation.”

“The study shows that it is possible to integrate electrical and mechanical information from the atria of patients with atrial fibrillation and thus obtain personalized prognostic information about the clinical evolution of the arrhythmia,” he adds.

The development of this type of research and its clinical implementation will allow for an increasingly personalized approach to patients with atrial fibrillation.

In addition, they highlight Nicosio Perez Castellanoof the IdISSC, and David Bald Ravenfrom the Hospital Central de Asturias and currently also a member of the IdISSC, “the proposed approach and the results obtained are underpinned by the non-invasive nature of this new diagnostic approach in the management of patients with atrial fibrillation.”

The co-author himself Julian Perez Villacastinclinical collaborator on the study at Hospital Clínico San Carlos and current President of the Spanish Society of Cardiology, adds that “the development of this type of research and its clinical implementation will allow for an increasingly personalized approach to patients with atrial fibrillation.”

This is particularly relevant in the current context of the increasing number of patients with atrial fibrillation who In Spain, more than 700,000 people are already affected and in Europe it exceeds 10 million diagnosed patients.

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