Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Studyopen access
- Authors
- Kim, In-Soo; Lim, Byounghyun; Shim, Jaemin; Hwang, Minki; Yu, Hee Tae; Kim, Tae-Noon; Uhm, Jae-Sun; Kim, Sung-Hwan; Joung, Boyoung; On, Young Keun; Oh, Seil; Oh, Yong-Seog; Nam, Gi-Byung; Lee, Moon-Hyoung; Shim, Eun Bo; Kim, Young-Noon; Pak, Hui-Nam
- Issue Date
- Dec-2019
- Publisher
- Frontiers Media S.A.
- Keywords
- atrial fibrillation; catheter ablation; virtual ablation; computational modeling; recurrence
- Citation
- Frontiers in Physiology, v.10
- Indexed
- SCIE
SCOPUS
- Journal Title
- Frontiers in Physiology
- Volume
- 10
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/1302
- DOI
- 10.3389/fphys.2019.01512
- ISSN
- 1664-042X
- 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.
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