Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study
ObjectiveCatheter 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.MethodsWe randomly assigned 118 patients with persistent...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-12-01
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| Series: | Frontiers in Physiology |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fphys.2019.01512/full |
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| author | 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 for the CUVIA-AF1 Investigators |
| author_facet | 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 for the CUVIA-AF1 Investigators |
| author_sort | In-Soo Kim |
| collection | DOAJ |
| description | ObjectiveCatheter 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.MethodsWe 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.ResultsDuring 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).ConclusionAmong patients with persistent AF, the computational modeling-guided ablation was superior to the empirical catheter ablation regarding the rhythm outcome.Clinical Trial RegistrationThis study was registered with the ClinicalTrials.gov, number NCT02171364. |
| first_indexed | 2024-12-20T16:31:30Z |
| format | Article |
| id | doaj.art-d7a98ad7e73e470ca01c5a629cb2ea19 |
| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-20T16:31:30Z |
| publishDate | 2019-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Physiology |
| spelling | doaj.art-d7a98ad7e73e470ca01c5a629cb2ea192022-12-21T19:33:15ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2019-12-011010.3389/fphys.2019.01512491301Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized StudyIn-Soo Kim0Byounghyun Lim1Jaemin Shim2Minki Hwang3Hee Tae Yu4Tae-Hoon Kim5Jae-Sun Uhm6Sung-Hwan Kim7Boyoung Joung8Young Keun On9Seil Oh10Yong-Seog Oh11Gi-Byung Nam12Moon-Hyoung Lee13Eun Bo Shim14Young-Hoon Kim15Hui-Nam Pak16for the CUVIA-AF1 InvestigatorsYonsei University Health System, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaCardiovascular Center, Korea University, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaDivision of Cardiology, Catholic University of Korea, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaSamsung Medical Center, Sungkyunkwan University, Seoul, South KoreaDivision of Cardiology, Seoul National University, Seoul, South KoreaDivision of Cardiology, Catholic University of Korea, Seoul, South KoreaAsan Medical Center, University of Ulsan, Ulsan, South KoreaYonsei University Health System, Seoul, South KoreaDepartment of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South KoreaCardiovascular Center, Korea University, Seoul, South KoreaYonsei University Health System, Seoul, South KoreaObjectiveCatheter 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.MethodsWe 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.ResultsDuring 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).ConclusionAmong patients with persistent AF, the computational modeling-guided ablation was superior to the empirical catheter ablation regarding the rhythm outcome.Clinical Trial RegistrationThis study was registered with the ClinicalTrials.gov, number NCT02171364.https://www.frontiersin.org/article/10.3389/fphys.2019.01512/fullatrial fibrillationcatheter ablationvirtual ablationcomputational modelingrecurrence |
| spellingShingle | 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 for the CUVIA-AF1 Investigators Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study Frontiers in Physiology atrial fibrillation catheter ablation virtual ablation computational modeling recurrence |
| title | Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study |
| title_full | Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study |
| title_fullStr | Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study |
| title_full_unstemmed | Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study |
| title_short | Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study |
| title_sort | clinical usefulness of computational modeling guided persistent atrial fibrillation ablation updated outcome of multicenter randomized study |
| topic | atrial fibrillation catheter ablation virtual ablation computational modeling recurrence |
| url | https://www.frontiersin.org/article/10.3389/fphys.2019.01512/full |
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