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

Authors
 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  ;  CUVIA-AF1 Investigators 
Citation
 FRONTIERS IN PHYSIOLOGY, Vol.10 : e1512, 2019-12 
Journal Title
 FRONTIERS IN PHYSIOLOGY 
Issue Date
2019-12
Keywords
atrial fibrillation ; catheter ablation ; computational modeling ; recurrence ; virtual ablation
Abstract
Objective: Catheter 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. Methods: We 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. Results: During 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). Conclusion: Among patients with persistent AF, the computational modeling-guided ablation was superior to the empirical catheter ablation regarding the rhythm outcome. Clinical trial registration: This study was registered with the ClinicalTrials.gov, number NCT02171364.
Files in This Item:
T201906352.pdf Download
DOI
10.3389/fphys.2019.01512
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > BioMedical Science Institute (의생명과학부) > 1. Journal Papers
5. Research Institutes (연구소) > Yonsei Cardiovascular Research Institute (심혈관연구소) > 1. Journal Papers
Yonsei Authors
Kim, In-Soo(김인수) ORCID logo https://orcid.org/0000-0003-2801-5514
Kim, Tae-Hoon(김태훈) ORCID logo https://orcid.org/0000-0003-4200-3456
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Yu, Hee Tae(유희태) ORCID logo https://orcid.org/0000-0002-6835-4759
Lee, Moon-Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lim, Byounghyun(임병현)
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
Hwang, Min Ki(황민기)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/175828
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