PULMONARY VEINS ISOLATION VS LINEAR RADIOFREQUENCY ABLATION IN PAROXYSMAL ATRIAL FIBRILLATION PATIENTS USING EITHER MATHEMATICAL SCANNING OR CLINICAL APPROACH
Aim: 1) to compare clinical results of linear ablation vs. PVI approach in patients with paroxysmal AF and 2) to estimate theoretical probability of 4-waves re-entry to eliminate as a results of simulation the both ablative techniques in 2D mathematical modeling of left atrium (LA).
Material and methods: Study was conducted on 20 pts (6 women, 51.4±13.6 years of age) with paroxysmal AF underwent index RFA. The first group consisted of 10 pts (3 women, 51.1±11.9 years of age, history of arrhythmia – 3.2±1.2 years) in whom ablation strategy consisted of LASSO technique PVI. The second group concluded of 10 pts (3 women, 51.1±12.9 years of age, history of arrhythmia
– 3.1±1.1 years) in whom ablation strategy consisted of wide-area circumferential lines application using CARTO-system.
As the first step numeric reconstruction of the autowave process in excitable tissues of the LA and the simulation of AF was performed using Fitzhugh-Nagumo. A special scanning method was used for calculating characteristics of autowave processes in a 2D mathematical model of the LA. As the second step simulation of circular (corresponding to LASSO approach) and linear ablation (corresponding to 3D approach) were performed.
Results: 7 pts of the first group vs 4 pts of the second group had early recurrences arrhythmia. AAD free effectiveness in the first/second groups was 80%/20% at 12 months respectively (ð=0.003).
There was no elimination of 4-waves re-entry around PVs after period equaling to re-entry period while circular LASSO-like ablation pattern was used. In contrast, linear ablation patterns suppress arrhythmias caused in 2D mathematical modeling of LA.
Conclusion: Mathematical scanning approach using linear ablation to simulate clinical impact suppressed 4-waves re-entry more effectively comparing to PVI-only modeling. Our clinical results are consistent with ablation formatting data obtained by means of 4-waves re-entry simulation in 2D mathematical modeling of the LA.