Current progress of computational modeling for guiding clinical atrial fibrillation ablation

Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias, associated with high morbidity, mortality, and healthcare costs, and it places a significant burden on both individuals and society. Anti-arrhythmic drugs are the most commonly used strategy for treating AF. However, drug therapy faces challenges because of its limited efficacy and potential side effects. Catheter ablation is widely used as an alternative treatment for AF. Nevertheless, because the mechanism of AF is not fully understood, the recurrence rate after ablation remains high. In addition, the outcomes of ablation can vary significantly between medical institutions and patients, especially for persistent AF. Therefore, the issue of which ablation strategy is optimal is still far from settled. Computational modeling has the advantages of repeatable operation, low cost, freedom from risk, and complete control, and is a useful tool for not only predicting the results of different ablation strategies on the same model but also finding optimal personalized ablation targets for clinical reference and even guidance. This review summarizes three-dimensional computational modeling simulations of catheter ablation for AF, from the early-stage attempts such as Maze III or circumferential pulmonary vein isolation to the latest advances based on personalized substrate-guided ablation. Finally, we summarize current developments and challenges and provide our perspectives and suggestions for future directions.

How synergy between mechanistic and statistical models is impacting research in atrial fibrillation

“…Over the past 2 decades, numerous anatomical structures have been suggested as sites from which non-pulmonary vein triggers might occur, including the posterior wall of the left atrium, the left atrial appendage, the superior vena cava, the crista terminalis, the fossa ovalis, the coronary sinus, the ligament of Marshall and adjacent to the atrioventricular valve annuli. Unfortunately, strong evidence to support improved clinical outcomes for any adjunctive ablation strategies is lacking and identifying functional localized target sites for ablation remains challenging ( Wu et al, 2021 ). This may be optimized by using digital twin techniques.…”