Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling

Comparison with clinical catheter ablation

Minki Hwang, Soon Sung Kwon, Jin Wi, Mijin Park, Hyun Seung Lee, Jin Seo Park, Young Seon Lee, Eun Bo Shim, huinam pak

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. Methods: We included 20 patients with AF (65% male, 60.1±10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI+L1, CPVI+L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. Results: 1. Virtual CPVI+L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (. n=16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI+L1,2 ablation in overall patients (2.19±1.28 vs. 2.91±1.04s, p=0.009) and in patients with PeAF (2.05±1.23 vs. 2.93±10.2s, p=0.004) compared with other protocols. Conclusion: Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI+L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.

Original languageEnglish
Pages (from-to)40-47
Number of pages8
JournalProgress in Biophysics and Molecular Biology
Volume116
Issue number1
DOIs
Publication statusPublished - 2014 Sep 1

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Catheter Ablation
Pulmonary Veins
Computer Simulation
Atrial Fibrillation
Cardiac Electrophysiologic Techniques
Maintenance
Recurrence

All Science Journal Classification (ASJC) codes

  • Biophysics
  • Molecular Biology

Cite this

Hwang, Minki ; Kwon, Soon Sung ; Wi, Jin ; Park, Mijin ; Lee, Hyun Seung ; Park, Jin Seo ; Lee, Young Seon ; Shim, Eun Bo ; pak, huinam. / Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling : Comparison with clinical catheter ablation. In: Progress in Biophysics and Molecular Biology. 2014 ; Vol. 116, No. 1. pp. 40-47.
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title = "Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: Comparison with clinical catheter ablation",
abstract = "Background: Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. Methods: We included 20 patients with AF (65{\%} male, 60.1±10.5 years old, 80{\%} persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI+L1, CPVI+L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. Results: 1. Virtual CPVI+L1,2 ablation showed the highest AF termination rate in overall patients (55{\%}) and PeAF patients (. n=16, 62.5{\%}). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI+L1,2 ablation in overall patients (2.19±1.28 vs. 2.91±1.04s, p=0.009) and in patients with PeAF (2.05±1.23 vs. 2.93±10.2s, p=0.004) compared with other protocols. Conclusion: Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI+L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.",
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Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling : Comparison with clinical catheter ablation. / Hwang, Minki; Kwon, Soon Sung; Wi, Jin; Park, Mijin; Lee, Hyun Seung; Park, Jin Seo; Lee, Young Seon; Shim, Eun Bo; pak, huinam.

In: Progress in Biophysics and Molecular Biology, Vol. 116, No. 1, 01.09.2014, p. 40-47.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling

T2 - Comparison with clinical catheter ablation

AU - Hwang, Minki

AU - Kwon, Soon Sung

AU - Wi, Jin

AU - Park, Mijin

AU - Lee, Hyun Seung

AU - Park, Jin Seo

AU - Lee, Young Seon

AU - Shim, Eun Bo

AU - pak, huinam

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N2 - Background: Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. Methods: We included 20 patients with AF (65% male, 60.1±10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI+L1, CPVI+L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. Results: 1. Virtual CPVI+L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (. n=16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI+L1,2 ablation in overall patients (2.19±1.28 vs. 2.91±1.04s, p=0.009) and in patients with PeAF (2.05±1.23 vs. 2.93±10.2s, p=0.004) compared with other protocols. Conclusion: Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI+L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.

AB - Background: Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. Methods: We included 20 patients with AF (65% male, 60.1±10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI+L1, CPVI+L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. Results: 1. Virtual CPVI+L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (. n=16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI+L1,2 ablation in overall patients (2.19±1.28 vs. 2.91±1.04s, p=0.009) and in patients with PeAF (2.05±1.23 vs. 2.93±10.2s, p=0.004) compared with other protocols. Conclusion: Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI+L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.

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