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Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study.


ABSTRACT:

Background and objectives

We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation.

Methods

In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax maps were generated by computational modeling based on atrial substrate maps acquired during clinical procedures in sinus rhythm. Smax maps were generated during the clinical PV isolation (PVI). The V-Smax group underwent an additional extra-PV ablation after PVI targeting the virtual high Smax sites.

Results

After a mean follow-up period of 12.3±5.2 months, the clinical recurrence rates (25.6% vs. 23.9% in the V-Smax and the E-ABL group, p=0.880) or recurrence appearing as atrial tachycardia (11.1% vs. 5.7%, p=0.169) did not differ between the 2 groups. The post-ablation cardioversion rate was higher in the V-Smax group than E-ABL group (14.4% vs. 5.7%, p=0.027). Among antiarrhythmic drug-free patients (n=129), the AF freedom rate was 78.7% in the V-Smax group and 80.9% in the E-ABL group (p=0.776). The total procedure time was longer in the V-Smax group (p=0.008), but no significant difference was found in the major complication rates (p=0.497) between the groups.

Conclusions

Unlike a dominant frequency ablation, the computational modeling-guided V-Smax ablation did not improve the rhythm outcome of the PeAF ablation and had a longer procedure time.

Trial registration

ClinicalTrials.gov Identifier: NCT02558699.

SUBMITTER: Choi Y 

PROVIDER: S-EPMC9470491 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study.

Choi Young Y   Lim Byounghyun B   Yang Song-Yi SY   Yang So-Hyun SH   Kwon Oh-Seok OS   Kim Daehoon D   Kim Yun Gi YG   Park Je-Wook JW   Yu Hee Tae HT   Kim Tae-Hoon TH   Yang Pil-Sung PS   Uhm Jae-Sun JS   Shim Jamin J   Kim Sung Hwan SH   Sung Jung-Hoon JH   Choi Jong-Il JI   Joung Boyoung B   Lee Moon-Hyoung MH   Kim Young-Hoon YH   Oh Yong-Seog YS   Pak Hui-Nam HN  

Korean circulation journal 20220711 9


<h4>Background and objectives</h4>We investigated whether extra-pulmonary vein (PV) ablation targeting a high maximal slope of the action potential duration restitution curve (Smax) improves the rhythm outcome of persistent atrial fibrillation (PeAF) ablation.<h4>Methods</h4>In this open-label, multi-center, randomized, and controlled trial, 178 PeAF patients were randomized with 1:1 ratio to computational modeling-guided virtual Smax ablation (V-Smax) or empirical ablation (E-ABL) groups. Smax  ...[more]

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