AUTHOR=Shim Jaemin , Hwang Minki , Song Jun-Seop , Lim Byounghyun , Kim Tae-Hoon , Joung Boyoung , Kim Sung-Hwan , Oh Yong-Seog , Nam Gi-Byung , On Young Keun , Oh Seil , Kim Young-Hoon , Pak Hui-Nam 

TITLE=Virtual In-Silico Modeling Guided Catheter Ablation Predicts Effective Linear Ablation Lesion Set for Longstanding Persistent Atrial Fibrillation: Multicenter Prospective Randomized Study

JOURNAL=Frontiers in Physiology

VOLUME=Volume 8 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2017.00792

DOI=10.3389/fphys.2017.00792

ISSN=1664-042X

ABSTRACT=Objective: Radiofrequency catheter ablation for persistent atrial fibrillation (PeAF) still has a substantial recurrence rate. This study aims to investigate whether an AF ablation lesion set chosen using in-silico ablation (V-ABL) is clinically feasible and more effective than an empirically chosen ablation lesion set (Em-ABL) in patients with PeAF.
Methods: We prospectively included 108 patients with antiarrhythmic drug-resistant PeAF (77.8% men, age 60.8±9.9 years), and randomly assigned them to the V-ABL (n=53) and Em-ABL (n=55) groups. Five different in-silico ablation lesion sets (1 pulmonary vein isolation (PVI), 3 linear ablations, and 1 electrogram-guided ablation) were compared using heart-CT integrated AF modeling. We evaluated the feasibility, safety, and efficacy of V-ABL compared with that of Em-ABL. 
Results: The pre-procedural computing time for 5 different ablation strategies was 166±11 min. In the Em-ABL group, the earliest terminating blinded in-silico lesion set matched with the Em-ABL lesion set in 21.8%. V-ABL was not inferior to Em-ABL in terms of procedure time (p=0.403), ablation time (p=0.510), and major complication rate (p=0.900). During 12.6±3.8 months of follow-up, the clinical recurrence rate was 14.0% in the V-ABL group and 18.9% in the Em-ABL group (p=0.538). In Em-ABL group, clinical recurrence rate was significantly lower after PVI+posterior box+anterior linear ablation, which showed the most frequent termination during in-silico ablation (log-rank p=0.027).
Conclusions: V-ABL was feasible in clinical practice, not inferior to Em-ABL, and predicts the most effective ablation lesion set in patients who underwent PeAF ablation.