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In Silico TRials guide optimal stratification of ATrIal FIbrillation patients to Catheter Ablation and pharmacological medicaTION: the i-STRATIFICATION study

Dasí, Albert; Nagel, Claudia 1; Pope, Michael T. B.; Wijesurendra, Rohan S.; Betts, Timothy R.; Sachetto, Rafael; Loewe, Axel ORCID iD icon 1; Bueno-Orovio, Alfonso; Rodriguez, Blanca
1 Institut für Biomedizinische Technik (IBT), Karlsruher Institut für Technologie (KIT)

Abstract:

Aims: Patients with persistent atrial fibrillation (AF) experience 50% recurrence despite pulmonary vein isolation (PVI), and no consensus is established for secondary treatments. The aim of our i-STRATIFICATION study is to provide evidence for stratifying patients with AF recurrence after PVI to optimal pharmacological and ablation therapies, through in silico trials.
Methods and results: A cohort of 800 virtual patients, with variability in atrial anatomy, electrophysiology, and tissue structure (low-voltage areas, LVAs), was developed and validated against clinical data from ionic currents to electrocardiogram. Virtual patients presenting AF post-PVI underwent 12 secondary treatments. Sustained AF developed in 522 virtual patients after PVI. Second ablation procedures involving left atrial ablation alone showed 55% efficacy, only succeeding in the small right atria (<60 mL). When additional cavo-tricuspid isthmus ablation was considered, Marshall-PLAN sufficed (66% efficacy) for the small left atria (<90 mL). For the bigger left atria, a more aggressive ablation approach was required, such as anterior mitral line (75% efficacy) or posterior wall isolation plus mitral isthmus ablation (77% efficacy). ... mehr


Verlagsausgabe §
DOI: 10.5445/IR/1000171979
Veröffentlicht am 27.06.2024
Originalveröffentlichung
DOI: 10.1093/europace/euae150
Scopus
Zitationen: 1
Web of Science
Zitationen: 1
Dimensions
Zitationen: 2
Cover der Publikation
Zugehörige Institution(en) am KIT Institut für Biomedizinische Technik (IBT)
Publikationstyp Zeitschriftenaufsatz
Publikationsjahr 2024
Sprache Englisch
Identifikator ISSN: 1099-5129, 1532-2092
KITopen-ID: 1000171979
Erschienen in Europace
Verlag Oxford University Press (OUP)
Band 26
Heft 6
Seiten Art.-Nr.: euae150
Vorab online veröffentlicht am 13.06.2024
Schlagwörter In silico trials, Atrial fibrillation, Stratification, Virtual patients, Catheter ablation, Pharmacological therapy
Nachgewiesen in Dimensions
Web of Science
Scopus
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