Key result
CUVIA2.5 simulated voltage and conduction maps achieve ~93% correlation with clinical maps during AF ablation.
Why the study?
Following previous reports on the feasibility of simulation-guided catheter ablation, the authors sought to develop and test the clinical feasibility of an efficient, realistic in silico AF model reflecting patient endocardial voltage and local conduction.
Does an in situ procedural simulation model accurately reflect patient endocardial voltage and local conduction during AF ablation?
Observational (n=27)
No
Does an in situ procedural simulation model accurately reflect patient endocardial voltage and local conduction during AF ablation?
Effect estimate: R = 0.933
p-value: p=<0.001
A highly efficient, realistic, in situ procedural simulation model accurately reflects individual anatomy and electrophysiology and can be applied during AF ablation procedures.
May facilitate individualized AF ablation mapping; leaves open impact on outcomes and needs prospective validation.
We previously reported the feasibility and efficacy of a simulation-guided clinical catheter ablation of atrial fibrillation (AF) in an in-silico AF model. We developed a highly efficient realistic AF model reflecting the patient endocardial voltage and local conduction and tested its clinical feasibility. We acquired > 500 endocardial bipolar electrograms during right atrial pacing at the beginning of the AF ablation procedures. Based on the clinical bipolar electrograms, we generated simulated voltage maps by applying fibrosis and local activation maps adjusted for the fiber orientation. The software's accuracy (CUVIA2.5) was retrospectively tested in 17 patients and feasibility prospectively in 10 during clinical AF ablation. Results: We found excellent correlations between the clinical and simulated voltage maps (R = 0.933, p < 0.001) and clinical and virtual local conduction (R = 0.958, p < 0.001). The proportion of virtual local fibrosis was 15.4, 22.2, and 36.9% in the paroxysmal AF, persistent AF, and post-pulmonary vein isolation (PVI) states, respectively. The reconstructed virtual bipolar electrogram exhibited a relatively good similarities of morphology to the local clinical bipolar electrogram (R = 0.60 ± 0.08, p < 0.001). Feasibility testing revealed an in situ procedural computing time from the clinical data acquisition to wave-dynamics analyses of 48.2 ± 4.9 min. All virtual analyses were successfully achieved during clinical PVI procedures. We developed a highly efficient, realistic, in situ procedural simulation model reflective of individual anatomy, fiber orientation, fibrosis, and electrophysiology that can be applied during AF ablation.
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Lim et al. (2020) conducted an observational in Atrial Fibrillation (n=27). CUVIA2.5 software for realistic AF modeling vs. Clinical electro-anatomical maps was evaluated on Correlation between clinical and simulated voltage maps (R = 0.933, p=<0.001). The CUVIA2.5 software generated simulated voltage and local conduction maps that showed excellent correlation with clinical maps (R = 0.933 and R = 0.958, respectively, p < 0.001) during atrial fibrillation ablation.
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