Impact of varying ablation patterns in a simulation model of persistent atrial fibrillation.
BACKGROUND
Several strategies of endovascular ablation with varying success rates and proarrhythmic effects have been proposed to treat persistent atrial fibrillation (AF). Evaluation of ablation patterns by computer simulation provides a tool for examination of its effectiveness and side effects.


RESULTS
A biophysical model of the human atria based on magnetic resonance imaging derived geometry and a membrane kinetics model was used. Uniform conduction properties were assigned to the monolayer surface representing the atria. After induction of AF by burst pacing, progressively broader ablation patterns were applied: (A) individual pulmonary vein isolation (PVI); (B) double ipsilateral PVI; (C) double PVI with a roofline; (D) double PVI with a lateral mitral isthmus line, and (E) double PVI with both linear lesions. In addition, the influence of incomplete linear lesions and dilated atria were simulated. The incidence of AF termination was found to increase from pattern (A) to (E). Atrial flutter rate increased with incomplete ablations and in dilated atria.


CONCLUSIONS
Computer simulation of various ablation patterns in persistent AF is feasible and can reproduce clinical results of catheter ablation. This model can be used to develop and simulate new ablation patterns and anticipate success rates and potential adverse effects.
Rotter
Martin
M
Hôpital Cardiologique du Haut-Lévêque and Université Victor Segalean Bordeaux II, Bordeaux, France. martin.rotter@gmx.ch
Dang
Lam
L
Jacquemet
Vincent
V
Virag
Nathalie
N
Kappenberger
Lukas
L
Haïssaguerre
Michel
M
D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000601:surgery*; D003198:Computer Simulation; D006325:Heart Atria / Q000503:physiopathology* / Q000601:surgery*; D006329:Heart Conduction System / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D008955:Models, Cardiovascular; D025321:Surgery, Computer-Assisted / Q000379:methods