AUTHOR=Kim In-Soo , Lim Byounghyun , Shim Jaemin , Hwang Minki , Yu Hee Tae , Kim Tae-Hoon , Uhm Jae-Sun , Kim Sung-Hwan , Joung Boyoung , On Young Keun , Oh Seil , Oh Yong-Seog , Nam Gi-Byung , Lee Moon-Hyoung , Shim Eun Bo , Kim Young-Hoon , Pak Hui-Nam ,  for the CUVIA-AF1 Investigators 

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

JOURNAL=Frontiers in Physiology

VOLUME=10

YEAR=2019

URL=https://www.frontiersin.org/journals/physiology/articles/10.3389/fphys.2019.01512

DOI=10.3389/fphys.2019.01512

ISSN=1664-042X

ABSTRACT=<sec><title>Objective</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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 <italic>p</italic> = 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], <italic>p</italic> = 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 &lt; 50 mm), ejection fraction ≥ 50%, and those without hypertension or diabetes (<italic>p</italic> &lt; 0.01). There were no significant differences between the groups for the total procedure time (<italic>p</italic> = 0.403), ablation time (<italic>p</italic> = 0.510), and major complication rate (<italic>p</italic> = 0.900).</p></sec><sec><title>Conclusion</title><p>Among patients with persistent AF, the computational modeling-guided ablation was superior to the empirical catheter ablation regarding the rhythm outcome.</p></sec><sec><title>Clinical Trial Registration</title><p>This study was registered with the <ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov" xmlns:xlink="http://www.w3.org/1999/xlink">ClinicalTrials.gov</ext-link>, number NCT02171364.</p></sec>