title: Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: comparison with clinical catheter ablation.
abstract: BACKGROUND
  Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations.
  
  
  METHODS
  We included 20 patients with AF (65% male, 60.1 ± 10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI + L1, CPVI + L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone.
  
  
  RESULTS
  1. Virtual CPVI + L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (n = 16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI + L1,2 ablation in overall patients (2.19 ± 1.28 vs. 2.91 ± 1.04 s, p = 0.009) and in patients with PeAF (2.05 ± 1.23 vs. 2.93 ± 10.2 s, p = 0.004) compared with other protocols.
  
  
  CONCLUSIONS
  Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI + L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.
authors.affiliation: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Minki
authors.initials: M
authors.lastname: Hwang
authors.affiliation: Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea.
authors.forename: Soon-Sung
authors.initials: SS
authors.lastname: Kwon
authors.affiliation: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jin
authors.initials: J
authors.lastname: Wi
authors.affiliation: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Mijin
authors.initials: M
authors.lastname: Park
authors.affiliation: Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea.
authors.forename: Hyun-Seung
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea.
authors.forename: Jin-Seo
authors.initials: JS
authors.lastname: Park
authors.affiliation: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Young-Seon
authors.initials: YS
authors.lastname: Lee
authors.affiliation: Department of Mechanical and Biomedical Engineering, Kangwon National University, Chuncheon, Kangwon-do, Republic of Korea. Electronic address: ebshim@kangwon.ac.kr.
authors.forename: Eun Bo
authors.initials: EB
authors.lastname: Shim
authors.affiliation: Division of Cardiology, Yonsei University Health System, Seoul, Republic of Korea. Electronic address: hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D001281:Atrial Fibrillation / Q000473:pathology / Q000503:physiopathology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation; D003198:Computer Simulation; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome; D014584:User-Computer Interface
keywords: Atrial fibrillation; Catheter ablation; Simulation; Virtual ablation