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Patient Specific Simulations Predict Efficacy of Ablation of Interatrial Connections for Treatment of Persistent Atrial Fibrillation

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  • euy232

    euy232_1_.pdf, 1 MB, application/pdf

    28/11/2018

    Final published version

    CC BY

King's Authors

Abstract

Aims: Treatments for persistent atrial fibrillation (AF) offer limited efficacy. One potential strategy aims to return the right atrium (RA) to sinus rhythm (SR) by ablating interatrial connections (IAC) to isolate the atria, but there is limited clinical data to evaluate this ablation approach. We aimed to use simulation to evaluate and predict patient-specific suitability for ablation of IAC to treat AF. Methods: Persistent AF was simulated in 12 patient-specific geometries, incorporating electrophysiological heterogeneity and fibers, with IAC at Bachmann’s bundle, the coronary sinus and fossa ovalis. Simulations were performed to test the effect of LA-to-RA frequency gradient and fibrotic remodelling on IAC ablation efficacy. During AF we simulated ablation of one, two or all three IAC, with or without pulmonary vein isolation and determined if this altered or terminated the arrhythmia. Results: For models without structural remodelling, ablating all IAC terminated RA arrhythmia in 83% of cases. Models with the LA-to-RA frequency gradient removed had an increased success rate (100% success). IAC ablation is less effective in cases with fibrotic remodelling (interstitial fibrosis 50% success rate; combination remodelling 67%). Mean number of phase singularities in the RA was higher pre-ablation for IAC failure (success: 0.6±0.8 vs failure: 3.2±2.5, p<0.001). Conclusion: This simulation study predicts that IAC ablation is effective in returning the RA to SR for many cases. Patient-specific modeling approaches have the potential to stratify patients prior to ablation by predicting if drivers are located in the LA or RA. We present a platform for predicting efficacy and informing patient selection for speculative treatments.

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