Computationally guided personalized targeted ablation of persistent atrial fibrillation

Nat Biomed Eng. 2019 Nov;3(11):870-879. doi: 10.1038/s41551-019-0437-9. Epub 2019 Aug 19.

Abstract

Atrial fibrillation (AF)-the most common arrhythmia-significantly increases the risk of stroke and heart failure. Although catheter ablation can restore normal heart rhythms, patients with persistent AF who develop atrial fibrosis often undergo multiple failed ablations, and thus increased procedural risks. Here, we present personalized computational modelling for the reliable predetermination of ablation targets, which are then used to guide the ablation procedure in patients with persistent AF and atrial fibrosis. First, we show that a computational model of the atria of patients identifies fibrotic tissue that, if ablated, will not sustain AF. Then, we report the results of integrating the target ablation sites in a clinical mapping system and testing its feasibility in ten patients with persistent AF. The computational prediction of ablation targets avoids lengthy electrical mapping and could improve the accuracy and efficacy of targeted AF ablation in patients while eliminating the need for repeat procedures.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Arrhythmias, Cardiac / surgery
  • Atrial Fibrillation / diagnostic imaging
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / methods*
  • Computational Biology / methods*
  • Feasibility Studies
  • Fibrosis
  • Heart Atria / surgery
  • Humans
  • Image Interpretation, Computer-Assisted
  • Imaging, Three-Dimensional
  • Magnetic Resonance Imaging
  • Prospective Studies
  • Surgery, Computer-Assisted / methods*