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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

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, ran...

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Autores principales: Choi, Young, Lim, Byounghyun, Yang, Song-Yi, Yang, So-Hyun, Kwon, Oh-Seok, Kim, Daehoon, Kim, Yun Gi, Park, Je-Wook, Yu, Hee Tae, Kim, Tae-Hoon, Yang, Pil-Sung, Uhm, Jae-Sun, Shim, Jamin, Kim, Sung Hwan, Sung, Jung-Hoon, Choi, Jong-il, Joung, Boyoung, Lee, Moon-Hyoung, Kim, Young-Hoon, Oh, Yong-Seog, Pak, Hui-Nam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Cardiology 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470491/
https://www.ncbi.nlm.nih.gov/pubmed/35927040
http://dx.doi.org/10.4070/kcj.2022.0113
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author Choi, Young
Lim, Byounghyun
Yang, Song-Yi
Yang, So-Hyun
Kwon, Oh-Seok
Kim, Daehoon
Kim, Yun Gi
Park, Je-Wook
Yu, Hee Tae
Kim, Tae-Hoon
Yang, Pil-Sung
Uhm, Jae-Sun
Shim, Jamin
Kim, Sung Hwan
Sung, Jung-Hoon
Choi, Jong-il
Joung, Boyoung
Lee, Moon-Hyoung
Kim, Young-Hoon
Oh, Yong-Seog
Pak, Hui-Nam
author_facet Choi, Young
Lim, Byounghyun
Yang, Song-Yi
Yang, So-Hyun
Kwon, Oh-Seok
Kim, Daehoon
Kim, Yun Gi
Park, Je-Wook
Yu, Hee Tae
Kim, Tae-Hoon
Yang, Pil-Sung
Uhm, Jae-Sun
Shim, Jamin
Kim, Sung Hwan
Sung, Jung-Hoon
Choi, Jong-il
Joung, Boyoung
Lee, Moon-Hyoung
Kim, Young-Hoon
Oh, Yong-Seog
Pak, Hui-Nam
author_sort Choi, Young
collection PubMed
description 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
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spelling pubmed-94704912022-09-16 Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study Choi, Young Lim, Byounghyun Yang, Song-Yi Yang, So-Hyun Kwon, Oh-Seok Kim, Daehoon Kim, Yun Gi Park, Je-Wook Yu, Hee Tae Kim, Tae-Hoon Yang, Pil-Sung Uhm, Jae-Sun Shim, Jamin Kim, Sung Hwan Sung, Jung-Hoon Choi, Jong-il Joung, Boyoung Lee, Moon-Hyoung Kim, Young-Hoon Oh, Yong-Seog Pak, Hui-Nam Korean Circ J Original Research 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 The Korean Society of Cardiology 2022-07-11 /pmc/articles/PMC9470491/ /pubmed/35927040 http://dx.doi.org/10.4070/kcj.2022.0113 Text en Copyright © 2022. The Korean Society of Cardiology https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0 (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Choi, Young
Lim, Byounghyun
Yang, Song-Yi
Yang, So-Hyun
Kwon, Oh-Seok
Kim, Daehoon
Kim, Yun Gi
Park, Je-Wook
Yu, Hee Tae
Kim, Tae-Hoon
Yang, Pil-Sung
Uhm, Jae-Sun
Shim, Jamin
Kim, Sung Hwan
Sung, Jung-Hoon
Choi, Jong-il
Joung, Boyoung
Lee, Moon-Hyoung
Kim, Young-Hoon
Oh, Yong-Seog
Pak, Hui-Nam
Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title_full Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title_fullStr Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title_full_unstemmed Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title_short Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
title_sort clinical usefulness of virtual ablation guided catheter ablation of atrial fibrillation targeting restitution parameter-guided catheter ablation: cuvia-regab prospective randomized study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9470491/
https://www.ncbi.nlm.nih.gov/pubmed/35927040
http://dx.doi.org/10.4070/kcj.2022.0113
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