
pmid: 25261813
Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations.We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone.1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols.Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.
Male, Patient-Specific Modeling, 610, Sensitivity and Specificity, Imaging, Heart Conduction System/physiopathology, User-Computer Interface, Imaging, Three-Dimensional, Models, Heart Conduction System, Three-Dimensional/methods, Atrial Fibrillation, Humans, Computer Simulation, Catheter Ablation*, Heart Conduction System/surgery*, Body Surface Potential Mapping, Models, Cardiovascular, Reproducibility of Results, Atrial Fibrillation/pathology, Atrial Fibrillation/surgery*, Middle Aged, Atrial fibrillation, Cardiovascular*, Computer-Assisted/methods*, Virtual ablation, Atrial Fibrillation/physiopathology*, Treatment Outcome, Heart Conduction System/pathology, Surgery, Computer-Assisted, Catheter Ablation, Feasibility Studies, Body Surface Potential Mapping/methods, Surgery, Catheter ablation, Female, Simulation
Male, Patient-Specific Modeling, 610, Sensitivity and Specificity, Imaging, Heart Conduction System/physiopathology, User-Computer Interface, Imaging, Three-Dimensional, Models, Heart Conduction System, Three-Dimensional/methods, Atrial Fibrillation, Humans, Computer Simulation, Catheter Ablation*, Heart Conduction System/surgery*, Body Surface Potential Mapping, Models, Cardiovascular, Reproducibility of Results, Atrial Fibrillation/pathology, Atrial Fibrillation/surgery*, Middle Aged, Atrial fibrillation, Cardiovascular*, Computer-Assisted/methods*, Virtual ablation, Atrial Fibrillation/physiopathology*, Treatment Outcome, Heart Conduction System/pathology, Surgery, Computer-Assisted, Catheter Ablation, Feasibility Studies, Body Surface Potential Mapping/methods, Surgery, Catheter ablation, Female, Simulation
| selected citations These citations are derived from selected sources. This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | 46 | |
| popularity This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network. | Top 10% | |
| influence This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically). | Top 10% | |
| impulse This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network. | Top 10% |
