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Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study

Authors
 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 
Citation
 Frontiers in Physiology, Vol.8 : 792, 2017 
Journal Title
 Frontiers in Physiology 
Issue Date
2017
Keywords
atrial fibrillation ; catheter ablation ; in-silico modeling ; recurrence ; virtual ablation
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.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/161371
DOI
10.3389/fphys.2017.00792
Appears in Collections:
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실)
1. Journal Papers (연구논문) > 1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부)
Yonsei Authors
김태훈(Kim, Tae-Hoon) ; 박희남(Pak, Hui Nam) ; 임병현(Lim, Byounghyun) ; 정보영(Joung, Bo Young)
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