A personalized in silico ablation strategy achieved >98% success while isolating only 5-6% of the left atrial myocardium, compared to up to 20% isolation with conventional strategies.
Does a personalized ablation strategy targeting high dominant frequency regions improve ablation success and reduce isolated myocardium compared to conventional strategies in computational models of persistent AF?
A novel personalized in silico ablation strategy targeting high dominant frequency regions successfully terminated simulated persistent AF while isolating significantly less atrial myocardium than conventional approaches.
AIMS: The long-term success rate of ablation therapy is still sub-optimal in patients with persistent atrial fibrillation (AF), mostly due to arrhythmia recurrence originating from arrhythmogenic sites outside the pulmonary veins. Computational modelling provides a framework to integrate and augment clinical data, potentially enabling the patient-specific identification of AF mechanisms and of the optimal ablation sites. We developed a technology to tailor ablations in anatomical and functional digital atrial twins of patients with persistent AF aiming to identify the most successful ablation strategy. METHODS AND RESULTS: Twenty-nine patient-specific computational models integrating clinical information from tomographic imaging and electro-anatomical activation time and voltage maps were generated. Areas sustaining AF were identified by a personalized induction protocol at multiple locations. State-of-the-art anatomical and substrate ablation strategies were compared with our proposed Personalized Ablation Lines (PersonAL) plan, which consists of iteratively targeting emergent high dominant frequency (HDF) regions, to identify the optimal ablation strategy. Localized ablations were connected to the closest non-conductive barrier to prevent recurrence of AF or atrial tachycardia. The first application of the HDF strategy had a success of >98% and isolated only 5-6% of the left atrial myocardium. In contrast, conventional ablation strategies targeting anatomical or structural substrate resulted in isolation of up to 20% of left atrial myocardium. After a second iteration of the HDF strategy, no further arrhythmia episode could be induced in any of the patient-specific models. CONCLUSION: The novel PersonAL in silico technology allows to unveil all AF-perpetuating areas and personalize ablation by leveraging atrial digital twins.
Azzolin et al. (Tue,) conducted a other in Persistent atrial fibrillation (n=29). Personalized Ablation Lines (PersonAL) plan vs. Conventional anatomical and substrate ablation strategies was evaluated on Ablation success and percentage of left atrial myocardium isolated. A personalized in silico ablation strategy achieved >98% success while isolating only 5-6% of the left atrial myocardium, compared to up to 20% isolation with conventional strategies.