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KMID : 0368120220520090699
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Korean Circulation Journal
2022 Volume.52 No. 9 p.699 ~ p.711
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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
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Choi Young
Lim Byoung-Hyun
Yang Song-Yi
Yang So-Hyun
Kwon Oh-Seok
Kim Dae-Hoon
Kim Yun-Gi
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 Bo-Young
Lee Moon-Hyoung
Kim Young-Hoon
Oh Yong-Seog
Pak Hui-Nam
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Abstract
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Background and Objectives: We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation.
Methods: In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax maps were generated by computational modeling based on atrial substrate maps acquired during clinical procedures in sinus rhythm. Smax maps were generated during the clinical PV isolation (PVI). The V-Smax group underwent an additional extra-PV ablation after PVI targeting the virtual high Smax sites.
Results: After a mean follow-up period of 12.3±5.2 months, the clinical recurrence rates (25.6% vs. 23.9% in the V-Smax and the E-ABL group, p=0.880) or recurrence appearing as atrial tachycardia (11.1% vs. 5.7%, p=0.169) did not differ between the 2 groups. The post-ablation cardioversion rate was higher in the V-Smax group than E-ABL group (14.4% vs. 5.7%, p=0.027). Among antiarrhythmic drug-free patients (n=129), the AF freedom rate was 78.7% in the V-Smax group and 80.9% in the E-ABL group (p=0.776). The total procedure time was longer in the V-Smax group (p=0.008), but no significant difference was found in the major complication rates (p=0.497) between the groups.
Conclusions: Unlike a dominant frequency ablation, the computational modeling-guided V-Smax ablation did not improve the rhythm outcome of the PeAF ablation and had a longer procedure time.
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KEYWORD
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Atrial fibrillation, Catheter ablation, Computer simulation, Action potential, Electrophysiology
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