Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study

Choi, Young; Lim, Byounghyun; Yang, Song-Yi; Yang, So-Hyun; Kwon, Oh-Seok; Kim, Daehoon; Park, Je‐Wook; Yu, Hee Tae; Kim, Tae-Hoon; Yang, Pil-Sung; Uhm, Jae Sun; Shim, Jamin; Kim, Sung‐Hwan; Sung, Jung‐Hoon; Choi, Jong‐Il; Joung, Boyoung; Lee, Moon Hyoung; Kim, Young-Hoon; Oh, Yong‐Seog; Pak, Hui Nam

doi:10.4070/kcj.2022.0113

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…The AF detection rate in the 24-h Holter test was only 13.6%. The status of AF rhythm control has been commonly assessed by a 24 to 48 hr Holter in previous studies [7,27], but our study result implies that this approach can significantly underestimate AF recurrence in this patient group. In addition, it is inferred that long-term ECG monitoring should be considered even in asymptomatic patients receiving drug therapy, considering that recurrent AF was detected in 43.3% of patients who did not report AF-related symptoms in this study.…”

Section: Detection For Drug-refractory Af By Extended Monitoringmentioning

confidence: 59%

Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

Kim,

Choi,

Lee

et al. 2023

Diagnostics

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Accurate assessment of the response to the antiarrhythmic drug (AAD) in atrial fibrillation (AF) is crucial to achieve adequate rhythm control. We evaluated the effectiveness of extended cardiac monitoring using an adhesive ECG patch in the detection of drug-refractory paroxysmal AF. Patients diagnosed with paroxysmal AF and receiving AAD therapy were enrolled. The subjects simultaneously underwent 11-day adhesive ECG patch monitoring and a 24-h Holter test. The primary study outcome was a detection rate of drug-refractory AF or atrial tachycardia (AT) lasting ≥30 s. A total of 59 patients were enrolled and completed the study examinations. AF or AT was detected in 28 (47.5%) patients by an 11-day ECG patch monitor and in 8 (13.6%) patients by a 24-h Holter test (p < 0.001). The 11-day ECG patch monitor identified an additional 20 patients (33.8%) with drug-refractory AF not detected by the 24-h Holter, and as a result, the treatment plan was changed in 11 patients (10 catheter ablations, one medication change). In conclusion, extended cardiac rhythm monitoring using an adhesive ECG patch in patients with paroxysmal AF under AAD therapy led to over a threefold higher detection of drug-refractory AF episodes, compared to the 24-h Holter test.

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Section: Detection For Drug-refractory Af By Extended Monitoringmentioning

confidence: 59%

Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

Kim,

Choi,

Lee

et al. 2023

Diagnostics

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“…Our current digital twin model program (CUVIA) has been developed based on bipolar electrogram (EGM) data, utilizing a standardized mapping system for a long time. We have continuously improved and evolved the program, gaining experience for its application in real-time ablation strategies through several randomized controlled trials, which were published 9 , 24 – 26 or are still ongoing. To enhance the development of a robust model, new mapping systems such as high-density mapping or noncontact dipole density mapping system 27 (Acutus Medical, Carlsbad, CA) might have certain advantages over contact mapping systems, as it allows obtaining high-resolution data points throughout the entire left atrium.…”

Section: Discussionmentioning

confidence: 99%

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

Jin,

Hwang,

Kim

et al. 2024

npj Digit. Med.

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Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov; Unique identifier: NCT02138695.

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Clinical usefulness of digital twin guided virtual amiodarone test in patients with atrial fibrillation ablation

Hwang,

Lim,

Kwon

et al. 2024

npj Digit. Med.

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It would be clinically valuable if the efficacy of antiarrhythmic drugs could be simulated in advance. We developed a digital twin to predict amiodarone efficacy in high-risk atrial fibrillation (AF) patients post-ablation. Virtual left atrium models were created from computed tomography and electroanatomical maps to simulate AF and evaluate its response to varying amiodarone concentrations. As the amiodarone concentration increased in the virtual setting, action potential duration lengthened, peak upstroke velocities decreased, and virtual AF termination became more frequent. Patients were classified into effective (those with virtually terminated AF at therapeutic doses) and ineffective groups. The one-year clinical outcomes after AF ablation showed significantly better results in the effective group compared to the ineffective group, with AF recurrence rates of 20.8% vs. 45.1% (log-rank p = 0.031, adjusted hazard ratio, 0.37 [0.14-0.98]; p = 0.046). This study highlights the potential of a digital twin-guided approach in predicting amiodarone’s effectiveness and improving personalized AF management. Clinical Trial Registration Name: The Evaluation for Prognostic Factors After Catheter Ablation of Atrial Fibrillation: Cohort Study, Registration number: NCT02138695. The date of registration: 2014-05. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02138695.

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Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study

Cited by 4 publications

References 22 publications

Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

Comparison of the 11-Day Adhesive ECG Patch Monitor and 24-h Holter Tests to Assess the Response to Antiarrhythmic Drug Therapy in Paroxysmal Atrial Fibrillation

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

Clinical usefulness of digital twin guided virtual amiodarone test in patients with atrial fibrillation ablation

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