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

Research output: Contribution to journalArticle

5 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

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Catheter Ablation
Computer Simulation
Atrial Fibrillation
Prospective Studies
Pulmonary Veins
Recurrence
Anti-Arrhythmia Agents
Safety

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • In-silico modeling
  • Recurrence
  • Virtual ablation

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)

Cite this

Virtual in-silico modeling guided catheter ablation predicts effective linear ablation lesion set for longstanding persistent atrial fibrillation : Multicenter prospective randomized study. / Shim, Jaemin; Hwang, Minki; Song, Jun Seop; Lim, Byounghyun; Kim, Tae Hoon; Joung, Boyoung; Kim, Sung Hwan; Oh, Yong Seog; Nam, Gi Byung; On, Young Keun; Oh, Seil; Kim, Young Hoon; Pak, Hui Nam.

In: Frontiers in Physiology, Vol. 8, No. OCT, 792, 11.10.2017.

Research output: Contribution to journalArticle

Shim, Jaemin ; Hwang, Minki ; Song, Jun Seop ; Lim, Byounghyun ; Kim, Tae Hoon ; Joung, Boyoung ; Kim, Sung Hwan ; Oh, Yong Seog ; Nam, Gi Byung ; On, Young Keun ; Oh, Seil ; Kim, Young Hoon ; Pak, Hui Nam. / Virtual in-silico modeling guided catheter ablation predicts effective linear ablation lesion set for longstanding persistent atrial fibrillation : Multicenter prospective randomized study. In: Frontiers in Physiology. 2017 ; Vol. 8, No. OCT.
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title = "Virtual in-silico modeling guided catheter ablation predicts effective linear ablation lesion set for longstanding persistent atrial fibrillation: Multicenter prospective randomized study",
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.",
keywords = "Atrial fibrillation, Catheter ablation, In-silico modeling, Recurrence, Virtual ablation",
author = "Jaemin Shim and Minki Hwang and Song, {Jun Seop} and Byounghyun Lim and Kim, {Tae Hoon} and Boyoung Joung and Kim, {Sung Hwan} and Oh, {Yong Seog} and Nam, {Gi Byung} and On, {Young Keun} and Seil Oh and Kim, {Young Hoon} and Pak, {Hui Nam}",
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T1 - Virtual in-silico modeling guided catheter ablation predicts effective linear ablation lesion set for longstanding persistent atrial fibrillation

T2 - Multicenter prospective randomized study

AU - Shim, Jaemin

AU - Hwang, Minki

AU - Song, Jun Seop

AU - Lim, Byounghyun

AU - Kim, Tae Hoon

AU - Joung, Boyoung

AU - Kim, Sung Hwan

AU - Oh, Yong Seog

AU - Nam, Gi Byung

AU - On, Young Keun

AU - Oh, Seil

AU - Kim, Young Hoon

AU - Pak, Hui Nam

PY - 2017/10/11

Y1 - 2017/10/11

N2 - 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.

AB - 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.

KW - Atrial fibrillation

KW - Catheter ablation

KW - In-silico modeling

KW - Recurrence

KW - Virtual ablation

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JO - Frontiers in Physiology

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SN - 1664-042X

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