Clinical Outcomes of Computational Virtual Mapping-Guided Catheter Ablation in Patients With Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Clinical Trial

Frontiers in Cardiovascular Medicine

the CUVIA-AF 2 Investigators¹  Junbeom Park²  Hui-Nam Pak³  Jae-Sun Uhm³  Song-Yi Yang³  Tae-Hoon Kim³  Moon-Hyoung Lee³  Oh-Seok Kwon³  Je-Wook Park³  Hee Tae Yu³  Boyoung Joung³  Byounghyun Lim³  Yong-Soo Baek⁴  Dae-Hyeok Kim⁴ 

[1] ;Division of Cardiology, Department of Internal Medicine, Ewha Womans University, Seoul, South Korea;Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, South Korea;Inha University College of Medicine and Inha University Hospital, Incheon, South Korea;

关键词: catheter ablation;    computational modeling;    recurrence;    dominant frequency;    atrial fibrillation;   

DOI  :  10.3389/fcvm.2021.772665

来源: DOAJ

【 摘 要 】

Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF.Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group.Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group (P = 0.018, log-rank). Recurrences appearing as atrial tachycardias (P = 0.145) and the cardioversion rates (P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group (P < 0.001). No significant difference was found in the major complication rates (P = 0.489) or total procedure time (P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016].Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF.Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.

【 授权许可】

Unknown