Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study

Abstract

BackgroundAlthough pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps).MethodsWe included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps.ResultsCompared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010).ConclusionCPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.

Atrial fibrillation: Insights from animal models, computational modeling, and clinical studies

“…that led to PVI ablation becoming the cornerstone of clinical therapy for AF, several computational models were developed to test the effectiveness of various PVI ablation strategies. 69 , 70 Using CT-based atrial models, Hwang et al. compared the outcome of different ablation strategies and concluded that the most effective one was PVI with posterior box isolation and anterior line ablation.…”

Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins

“…AF digital twins can simulate the results of various virtual interventions under identical and reproducible conditions without posing ethical concerns 10 . Recently, we reported a digital twin study that could evaluate AF wave dynamics and rhythm outcomes by creating PVI gap models 11 . Therefore, we utilized a realistic human AF digital twin, incorporating the left atrial (LA) anatomy and electrophysiology of 50 AF cases.…”

Ablation and antiarrhythmic drug effects on PITX2+/− deficient atrial fibrillation: A computational modeling study

“…With recent improvements in computational technology and power, sophisticated AF computation modeling has become possible. Virtual ablation or virtual AAD responses can be tested on a virtual twin that reflects the anatomy, fibrosis, fiber orientation, and electrophysiological characteristics of patients with AF, and the wave dynamics generated from hundreds of thousands of nodes can also be evaluated ( 15 – 18 ).…”