Author + information
- E. Zhelyakov,
- A. Ardashev,
- M. Mazurov and
- V. Finko
1) to estimate theoretical probability of 4- and 6-waves re-entry to eliminate as a results of linear ablation simulation in 2D-mathematical modeling of left atrium (LA); 2) to extrapolate mathematical modeling data to clinical results of linear ablation in patients with paroxysmal and persistent AF.
Material and methods
Study was conducted on 40 pts with paroxysmal and persistent AF. First group (paroxysmal) included 20 pts (6 women, 51.4±13.6 years of age) with paroxysmal AF, who were divided into 2 age-sex-arrhythmia duration subgroups (A and B). The subgroup A consisted of 10 pts in whom ablation strategy consisted of PVI using LASSO approach. The subgroup B concluded of 10 pts in whom ablation strategy consisted of antral isolation of PVs added by roof and mitral isthmus lines. Second group (persistent) concluded 20 pts (6 women, 58.2±10.6 years of age, duration of arrhythmia – 7.1±1.1 years) with persistent AF who underwent index circumferential ablation combined with roof and mitral isthmus lines. We evaluated AF CL into the CS during procedure. The numeric reconstruction of the autowave process and the simulation of 4- and 6-wave re-entry AF was performed using Fitzhugh-Nagumo equation. A special scanning method was used for calculating characteristics of autowave processes in 2D mathematical model of LA. Then simulation of circular (corresponding to LASSO approach) and linear ablation (corresponding to linear approach) were performed.
In the first group 7 pts of the subgroup A vs 4 pts of the subgroup B had early recurrences of arrhythmia. AAD free effectiveness in the A/B subgroups was 80%/20% at 12 months respectively (p=0,003). In the second group organization of AF cycle length (from 112±24 to 204±35 ms) was verified in 12 of 20 pts during ablation. There was no elimination of 4-waves re-entry around the PV and vortex waves caused by them in a distributed 2D medium while circular LASSO-like ablation pattern was used. In contrast, linear ablation patterns suppressed arrhythmias caused by 4-waves re-entry. Ablation formatting (corresponding to linear ablation) transformed 6-wave reentry to 4 wave re-entry.
For paroxysmal AF mathematical ablation formating suppressed 4-waves re-entry more effectively comparing to LASSO approach only. Mathematical modeling of 6-wave reentry and linear ablation formatting may simulate persistent AF and subsequent AF organization result of antral and linear ablation. Our clinical results are consistent with ablation modeling data.