Frontiers in Physiology (Dec 2019)

Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study

  • In-Soo Kim,
  • Byounghyun Lim,
  • Jaemin Shim,
  • Minki Hwang,
  • Hee Tae Yu,
  • Tae-Hoon Kim,
  • Jae-Sun Uhm,
  • Sung-Hwan Kim,
  • Boyoung Joung,
  • Young Keun On,
  • Seil Oh,
  • Yong-Seog Oh,
  • Gi-Byung Nam,
  • Moon-Hyoung Lee,
  • Eun Bo Shim,
  • Young-Hoon Kim,
  • Hui-Nam Pak,
  • for the CUVIA-AF1 Investigators

DOI
https://doi.org/10.3389/fphys.2019.01512
Journal volume & issue
Vol. 10

Abstract

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ObjectiveCatheter ablation of persistent atrial fibrillation (AF) is still challenging, no optimal extra-pulmonary vein lesion set is known. We previously reported the clinical feasibility of computational modeling-guided AF catheter ablation.MethodsWe randomly assigned 118 patients with persistent AF (77.8% men, age 60.8 ± 9.9 years) to the computational modeling-guided ablation group (53 patients) and the empirical ablation group (55 patients) based on the operators’ experience. For virtual ablation, four virtual linear and one electrogram-guided lesion sets were tested on patient heart computed tomogram-based models, and the lesion set with the fastest termination time was reported to the operator in the modeling-guided ablation group. The primary outcome was freedom from atrial tachyarrhythmias lasting longer than 30 s after a single procedure.ResultsDuring 31.5 ± 9.4 months, virtual ablation procedures were available in 95.2% of the patients (108/118). Clinical recurrence rate was significantly lower after a modeling-guided ablation than after an empirical ablation (20.8 vs. 40.0%, log-rank p = 0.042). Modeling-guided ablation was independently associated with a better long-term rhythm outcome of persistent AF ablation (HR = 0.29 [0.12–0.69], p = 0.005). The rhythm outcome of the modeling-guided ablation showed better trends in males, non-obese patients with a less remodeled atrium (left atrial dimension < 50 mm), ejection fraction ≥ 50%, and those without hypertension or diabetes (p < 0.01). There were no significant differences between the groups for the total procedure time (p = 0.403), ablation time (p = 0.510), and major complication rate (p = 0.900).ConclusionAmong patients with persistent AF, the computational modeling-guided ablation was superior to the empirical catheter ablation regarding the rhythm outcome.Clinical Trial RegistrationThis study was registered with the ClinicalTrials.gov, number NCT02171364.

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