Current progress of computational modeling for guiding clinical atrial fibrillation ablation

Abstract

Atrial fibrillation (AF) is one of the most common arrhythmias, associated with high morbidity, mortality, and healthcare costs, and it places a significant burden on both individuals and society. Anti-arrhythmic drugs are the most commonly used strategy for treating AF. However, drug therapy faces challenges because of its limited efficacy and potential side effects. Catheter ablation is widely used as an alternative treatment for AF. Nevertheless, because the mechanism of AF is not fully understood, the recurrence rate after ablation remains high. In addition, the outcomes of ablation can vary significantly between medical institutions and patients, especially for persistent AF. Therefore, the issue of which ablation strategy is optimal is still far from settled. Computational modeling has the advantages of repeatable operation, low cost, freedom from risk, and complete control, and is a useful tool for not only predicting the results of different ablation strategies on the same model but also finding optimal personalized ablation targets for clinical reference and even guidance. This review summarizes three-dimensional computational modeling simulations of catheter ablation for AF, from the early-stage attempts such as Maze III or circumferential pulmonary vein isolation to the latest advances based on personalized substrate-guided ablation. Finally, we summarize current developments and challenges and provide our perspectives and suggestions for future directions.

概要

房颤(atrial fibrillation, AF)是最常见的心律失常之一, 临床危害极大. 虽然抗心律失常药物是治疗房颤最常用的策略, 但是药物治疗因其有限的疗效和潜在的副作用而面临挑战. 导管消融术作为一种替代方案被广泛用于治疗房颤患者. 然而, 由于房颤的机制还不完全清楚, 消融术后的复发率仍然很高, 尤其是持续性房颤. 因此, 何种消融策略是最优的一直是临床亟待解决的问题. 计算模型具有可重复操作、 低成本、 低风险和灵活可控等优点, 不仅可以在同一模型上预测不同消融策略的结果, 还可以找到最佳的个性化消融靶点供临床参考. 本综述总结了三维计算模型仿真房颤导管消融策略的进展, 从早期的迷宫术或环肺静脉隔离术到基于特异性底物的个性化消融方式. 最后, 我们总结了目前的发展和面临的挑战, 并对未来的发展方向提出了看法和建议.