Search

Background 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. Methods 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. Results 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. Conclusion 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. [ABSTRACT FROM AUTHOR]

Introduction Although ventricular tachycardia/fibrillation (VT/VF) develops suddenly with catastrophic results, its prediction is limited. We tested the fibrillation number (FibN) for potential predictor of VT/VF using clinical data of implantable cardioverter-defibrillator (ICD) patients after validating the number by computational modeling. Methods For clinical application of FibN, we used electrocardiography and echocardiography data: QRS width, QTc, and left ventricular (LV) end-systolic dimension (FibN VT/ VF 1) or LV end-diastolic dimension (FibN VT/VF 2). We compared the maintenance duration of VT/VF for various FibN values using computational modeling, and tested FibN VT/VF in 142 patients with ICD for secondary prevention and 426 patients in age-sex matched control group (81.9% male, 56.1 ± 12.3 years old). Results 1. Computational results showed a positive correlation between VT/VF maintenance duration and FibN ( R = 0.82, p < 0.001). 2. FibN VT/VF s were significantly higher in patients with ICD than in control (both FibN VT/VF 1 and FibN VT/VF 2, p < 0.001). 3. Within ICD group, FibN VT/VF values were higher in patients with cardiomyopathy than those without (both FibN VT/VF 1 and FibN VT/VF 2, p < 0.001). 4. During 50 ± 39 months follow-up period, the frequency of appropriate ICD therapy was higher in the high FibN VT/VF group (FibN VT/VF 1, p = 0.001; FibN VT/VF 2, p = 0.002). Both FibN VT/VF 1 (HR 2.51, 95%CI 1.48–4.24, p = 0.001) and FibN VT/VF 2 (HR 2.11, 95%CI 1.25–3.55, p = 0.005) were independently associated with appropriate ICD therapy in multi-variate analyses. Conclusion FibN VT/VF , a parameter based on wavelength and heart size, correlates well with maintenance of VT/VF in computational modeling, and may have predictive value for VT/VF events in patients with ICD for secondary prevention. [ABSTRACT FROM AUTHOR]