Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study

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; CUVIA-AF1 Investigators

doi:10.3389/fphys.2019.01512

Clinical Usefulness of Computational Modeling-Guided Persistent Atrial Fibrillation Ablation: Updated Outcome of Multicenter Randomized Study

Front Physiol. 2019 Dec 17:10:1512. doi: 10.3389/fphys.2019.01512. eCollection 2019.

Authors

In-Soo Kim¹, Byounghyun Lim¹, Jaemin Shim², Minki Hwang¹, Hee Tae Yu¹, Tae-Hoon Kim¹, Jae-Sun Uhm¹, Sung-Hwan Kim³, Boyoung Joung¹, Young Keun On⁴, Seil Oh⁵, Yong-Seog Oh³, Gi-Byung Nam⁶, Moon-Hyoung Lee¹, Eun Bo Shim⁷, Young-Hoon Kim², Hui-Nam Pak¹; CUVIA-AF1 Investigators

Affiliations

¹ Yonsei University Health System, Seoul, South Korea.
² Cardiovascular Center, Korea University, Seoul, South Korea.
³ Division of Cardiology, Catholic University of Korea, Seoul, South Korea.
⁴ Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea.
⁵ Division of Cardiology, Seoul National University, Seoul, South Korea.
⁶ Asan Medical Center, University of Ulsan, Ulsan, South Korea.
⁷ Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, South Korea.

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.

Keywords: atrial fibrillation; catheter ablation; computational modeling; recurrence; virtual ablation.

Associated data

ClinicalTrials.gov/NCT02171364