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).