Future Gene Therapeutic Solutions

Targeted Delivery of Gene Therapy Using Activation Mapping and Imaging

Since the description of the role of structural remodeling in AF, there has been increasing research on atrial fibrosis in the pathophysiology of AF.117 Imaging methods have been developed to detect, localize, and quantify atrial fibrosis, which correlated with outcomes such as stroke and recurrence of AF.118,119In vivo activation mapping methods may allow targeted therapy of AF-specific mechanisms and may detect atrial substrates and mechanisms initiating and/or maintaining AF.120,121 Advances in percutaneous catheter-based techniques with fluoroscopic and electroanatomic guidance should allow a less invasive, transendocardial gene delivery. Importantly, electroanatomical mapping may be useful to allow clear delineation of the region of interest and targeted deployment of the therapeutic product.122 This could be applicable not only in the ventricle (i.e. in the presence of chronic ischemic heart disease and subacute myocardial infarction) but also in the atria (i.e. targeting focal structural or electrical remodeling).