Left atrial model reconstruction in atrial fibrillation ablation: reliability of new mapping and complex impedance systems.

AIMS: The effectiveness of atrial fibrillation (AF) ablation relies on detailed knowledge of the anatomy of the left atrium (LA) and pulmonary veins (PVs). It is common to combine computed tomography/magnetic resonance (CT/MR) with imaging by electroanatomical (EA) mapping systems. The aim of this study was to evaluate the accuracy of LA anatomical reconstruction by 'One Model' and 'VeriSense' tools (Ensite Velocity 3.0, St Jude Medical), compared with CT/MR imaging. METHODS AND RESULTS: Seventy-two patients with AF underwent pre-procedural imaging (97% CT-scan, 3% MR imaging) and transcatheter ablation of PVs. Operators were blinded to CT/MR imaging. Electrical Coupling Index (ECI) was used to recognize venous structures when the circular catheter could not. The LA 'One Model' map was obtained without complications; all 124 main left PVs and 144 main right PVs were detected. Nine of 9 intermediate right PVs and 30 of 30 early branches were detected, whereas 1 of the 27 early branches on the right inferior PVs was missed. Comparison between LA intervein distances measured on the roof (RO) and the posterior wall (PW) showed a high correspondence between the EA model and CT/MR imaging (RO CT/MR imaging vs. EA: 32 ± 7 vs. 32 ± 7 mm; PW CT/MR imaging vs. EA: 36 ± 6 vs. 36 ± 7 mm). The EA model yielded slightly larger PV ostia diameters, owing to the distortion caused by catheter pressure. CONCLUSIONS: Recent 3D mapping tools allow outstanding anatomical rendering and are key in complex ablation procedure set-up. This study shows that 3D anatomical reconstruction of LA, PVs, and their variable branches is not only safe and fast but also accurate and reliable.

Interplay between Developmental Flexibility and Determinism in the Evolution of Mimetic Heliconius Wing Patterns.

To what extent can we predict how evolution occurs? Do genetic architectures and developmental processes canalize the evolution of similar outcomes in a predictable manner? Or do historical contingencies impose alternative pathways to answer the same challenge? Examples of Müllerian mimicry between distantly related butterfly species provide natural replicates of evolution, allowing us to test whether identical wing patterns followed parallel or novel trajectories. Here, we explore the role that the signaling ligand WntA plays in generating mimetic wing patterns in Heliconius butterflies, a group with extraordinary mimicry-related wing pattern diversity. The radiation is relatively young, and numerous cases of wing pattern mimicry have evolved within the last 2.5-4.5 Ma. WntA is an important target of natural selection and is one of four major effect loci that underlie much of the pattern variation in the group. We used CRISPR/Cas9 targeted mutagenesis to generate WntA-deficient wings in 12 species and a further 10 intraspecific variants, including three co-mimetic pairs. In all tested butterflies, WntA knockouts affect pattern broadly and cause a shift among every possible scale cell type. Interestingly, the co-mimics lacking WntA were very different, suggesting that the gene networks that pattern a wing have diverged considerably among different lineages. Thus, although natural selection channeled phenotypic convergence, divergent developmental contexts between the two major Heliconius lineages opened different developmental routes to evolve resemblance. Consequently, even under very deterministic evolutionary scenarios, our results underscore a surprising unpredictability in the developmental paths underlying convergence in a recent radiation.