A biophysical model of human atria suggests the Maze III procedure could be simplified to a right atrial pattern with a single line joining both vena cavae, achieving 100% success in AF termination.
Do simplified ablation patterns achieve similar sinus rhythm conversion as the Maze III procedure in a biophysical model of human atria with chronic AF?
A biophysical model suggests that the Maze III procedure could be simplified in its right atrial pattern to a single line joining both vena cavae while maintaining 100% success in AF termination.
Absolute Event Rate: 100% vs 100%
Objective: The surgical Maze III procedure remains the gold standard in treating atrial fibrillation (AF); however due to clinical difficulties and higher risks, less invasive ablation alternatives are clinically investigated. The present study aims to define more efficient ablation patterns of the modified maze procedure using a biophysical model of human atria with chronic AF. Methods: A three-dimensional model of human atria was developed using both MRI-imaging and a one-layer cellular model reproducing experimentally observed atrial cellular properties. Sustained AF could be induced by a burst-pacing protocol. Ablation lines were implemented in rendering the cardiac cells non-conductive, mimicking transmural lines. Lines were progressively implemented respectively around pulmonary veins (PV), left atrial appendage (LAA), left atrial isthmus (LAI), cavo-tricuspid isthmus (CTI), and intercaval lines (SIVC) in the computer model, defining the following patterns: P1 = PV, P2 = P1 + LAA, P3 = P2 + LAI, P4 = P3 + CTI, P5 = P3 + SIVC, P6 = P5 + CTI. Forty simulations were done for each pattern and proportion of sinus rhythm (SR) conversion and time-to-AF termination (TAFT) were assessed. Results: The most efficient patterns are P5, P6, and Maze III with 100% success. The main difference is expressed in decreasing mean TAFT with a correlation coefficient R = −0.8. There is an inflexion point for 100% success rate at a 7.5 s TAFT, meaning that no additional line is mandatory beyond pattern P5. Conclusions: Our biophysical model suggests that Maze III could be simplified in his right atrial pattern to a single line joining both vena cavae. This has to be confirmed in clinical settings.
Ruchat et al. (Thu,) conducted a other in Atrial fibrillation. Modified maze ablation patterns (P1-P6) vs. Maze III was evaluated on Proportion of sinus rhythm (SR) conversion and time-to-AF termination (TAFT). A biophysical model of human atria suggests the Maze III procedure could be simplified to a right atrial pattern with a single line joining both vena cavae, achieving 100% success in AF termination.