This opportunity relates to the development of personalised maps to guide cardiac ablation as a treatment for Atrial Fibrillation in drug refractory patients. The inventors can identify tissue capable of sustaining AF by characterising a model of cardiac electrical activity and then simulating the capacity of the cardiac tissue to maintain a “spiral wave”. This allows the identification of potential tissue ablation targets from the heart during sinus rhythm.
Atrial fibrillation is the most common cardiac arrhythmia. In drug refractory patients, ablation to remove or isolate pathological tissue is a routine treatment during catheterisation. Selecting target sites to ablate is sub-optimal currently, often requiring multiple procedures.
Our hypothesis is that atrial fibrillation is driven by tissue that can sustain functional re-entrant activation patterns. We aimed to identify regions of tissue that have electrical characteristics (action potential duration restitution and conduction velocity restitution) that can sustain a re-entrant activation pattern (spiral wave) and as such can act as functional drivers for atrial fibrillation and, if ablated, would remove the atria’s capacity to sustain an arrhythmia.
While pulmonary vein isolation is effective in paroxysmal atrial fibrillation (AF) patients its success rate in the more severe persistent AF patients is lower with many patients requiring multiple procedures and more extensive ablations. Previous strategies have aimed at identifying ablation targets by identifying complex fractionated electrograms (CAFE mapping) or focal or re-entrant activation patterns (FIRM mapping). However, both these approaches remain controversial and have not been widely adopted.
Led by Dr Steven Niederer, King’s researchers have created a new method for developing models of cardiac myocyte electrophysiology from clinical electrogram measurements (see Fig 1).
This approach allows simulation of tissue electrophysiology under conditions that were not initially recorded. By first characterising a model of local tissue electro-physiology and then simulating the capacity of the tissue to maintain a spiral wave in a model of cardiac tissue, the inventors can identify tissue capable of sustaining AF (see Fig. 2). This allows the identification of potential tissue ablation targets from the heart during controlled pacing protocols during sinus rhythm. It also allows multiple ablation sites to be identified.
Collaborative research is underway to improve the usability of the models in planning and guiding clinical treatment. King’s has a pending patent application protecting the approach and is seeking a development partner to commercialise the technology.
A priority application was filed in May 2016 and an International PCT application is planned in May 2017. The GB Search indicates that the specific embodiment disclosed is likely to be patentable.
KCL Principle Investigator: Dr Steven Niederer, Imaging Sciences & Biomedical Engineering Division
Dr Ceri J. Mathews
IP & Licensing Manager
King’s College London