Table_1_Anti-atrial Fibrillation Effects of Pulmonary Vein Isolation With or Without Ablation Gaps: A Computational Modeling Study.DOCX

BackgroundAlthough pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps).
MethodsWe included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps.
ResultsCompared with the baseline AF, CPVIs significantly reduced extra-PV DFs (p < 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps (p < 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p < 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively (p = 0.010).
ConclusionCPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.

背景 尽管肺静脉隔离（pulmonary vein isolation, PVI）缝隙会增加心房颤动（atrial fibrillation, AF）导管消融术后的复发风险，但其具体机制尚未明确。本研究采用逼真的人类AF计算模型，探究存在缝隙的PVI（PVI-gaps）对AF波动力学的影响。
方法 本研究纳入40例行AF导管消融的患者（其中男性占80%，年龄61.0±9.8岁，持续性心房颤动（persistent AF）占92.5%），以此构建逼真的人类AF计算模型。通过评估主导频率（dominant frequency, DF）、DF空间分布变化、动作电位时程恢复曲线最大斜率（Smax）以及AF碎裂终止率（即AF终止或转为房性心动过速（atrial tachycardia）），比较完全肺静脉隔离（complete PVI, CPVI）与PVI缝隙（2mm×4）对AF波动力学的影响；并测试额外虚拟消融干预及氟卡尼（flecainide）对存在PVI缝隙的持续性心房颤动的治疗效果。
结果 与基线AF状态相比，CPVI可显著降低肺静脉外（extra-PV）区域的DF（p<0.001），而PVI缝隙组无此效应。CPVI术后的DF变异系数（COV-DFs）显著高于PVI缝隙组（p<0.001）。CPVI与PVI缝隙均未改变平均Smax。CPVI组的AF碎裂终止率达80%，显著高于PVI缝隙组的12.5%（p<0.001）。在存在PVI缝隙的持续性AF模型中，行波破裂缝隙消融、肺静脉外（extra-PV）区域DF消融或氟卡尼治疗后的AF碎裂终止率分别为60.0%、34.3%和25.7%（p=0.010）。
结论 在PVI缝隙状态下，CPVI可有效降低DF水平，增加肺静脉外区域DF的空间异质性，且其抗AF效果优于单纯肺静脉外（extra-PV）区域DF消融或额外使用氟卡尼治疗。