Virtual ablation for atrial fibrillation in personalized in-silico three-dimensional left atrial modeling: Comparison with clinical catheter ablation

Background: Although catheter ablation is an effective rhythm control strategy for atrial fibrillation (AF), empirically-based ablation has a substantial recurrence rate. The purposes of this study were to develop a computational platform for patient-specific virtual AF ablation and to compare the anti-fibrillatory effects of 5 different virtual ablation protocols with empirically chosen clinical ablations. Methods: We included 20 patients with AF (65% male, 60.1±10.5 years old, 80% persistent AF [PeAF]) who had undergone empirically-based catheter ablation: circumferential pulmonary vein isolation (CPVI) for paroxysmal AF (PAF) and additional posterior box lesion (L1) and anterior line (L2) for PeAF. Using patient-specific three-dimensional left atrial (LA) geometry, we generated a finite element model and tested the AF termination rate after 5 different virtual ablations: CPVI alone, CPVI+L1, CPVI+L1,2, CPVI with complex fractionated atrial electrogram (CFAE) ablation, and CFAE ablation alone. Results: 1. Virtual CPVI+L1,2 ablation showed the highest AF termination rate in overall patients (55%) and PeAF patients (. n=16, 62.5%). 2. The virtual AF maintenance duration was shortest in the case of virtual CPVI+L1,2 ablation in overall patients (2.19±1.28 vs. 2.91±1.04s, p=0.009) and in patients with PeAF (2.05±1.23 vs. 2.93±10.2s, p=0.004) compared with other protocols. Conclusion: Virtual AF ablation using personalized in-silico model of LA is feasible. Virtual ablation with CPVI+L1,2 shows the highest antifibrillatory effect, concordant with the empirical ablation protocol in patients with PeAF.