Virtual in-silico modeling guided catheter ablation predicts effective linear ablation lesion set for longstanding persistent atrial fibrillation: Multicenter prospective randomized study

Jaemin Shim, Minki Hwang, Jun Seop Song, Byounghyun Lim, Tae Hoon Kim, Boyoung Joung, Sung Hwan Kim, Yong Seog Oh, Gi Byung Nam, Young Keun On, Seil Oh, Young Hoon Kim, Hui Nam Pak

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10 Citations (Scopus)

Abstract

Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF. Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8 ± 9.9 years), and randomly assigned them to the V-ABL (n = 53) and Em-ABL (n = 55) groups. Five different in-silico ablation lesion sets [1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation] were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. Results: The pre-procedural computing time for five different ablation strategies was 166 ± 11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time (p = 0.403), ablation time (p = 0.510), and major complication rate (p = 0.900). During 12.6 ± 3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group (p = 0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p = 0.027). Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.

Original languageEnglish
Article number792
JournalFrontiers in Physiology
Volume8
Issue numberOCT
DOIs
Publication statusPublished - 2017 Oct 11

All Science Journal Classification (ASJC) codes

  • Physiology
  • Physiology (medical)

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