Abstract
Atrial fibrillation (AF) is the most common form of cardiac arrhythmia.
Surgical/Radiofrequency (RF) ablation is a therapeutic procedure
that consists of creating lines of conduction block to interrupt
AF. The present study evaluated 13 different ablation patterns by
means of a biophysical model of the human atria. In this model, ablation
lines were abruptly applied transmurally during simulated sustained
AF, and success rate, time to AF termination and average beat-to-beat
interval were documented. The gold standard Cox's Maze III procedure
was taken as reference. The effectiveness of twelve less invasive
patterns was compared to it. In some of these incomplete lines (entailing
a gap) were simulated. Finally, the computer simulations were compared
to clinical data. The results show that the model reproduces observations
made in vivo: (1) the Maze III is the most efficient ablation procedure;
(2) less invasive patterns should include lines in both right and
left atrium; (3) incomplete ablation lines between the pulmonary
veins and the mitral valve annulus lead to uncommon flutter; (4)
computer simulations of incomplete lines are consistent with clinical
results of non-transumural RF ablation. Biophysical modeling may
therefore be considered as a useful tool for understanding the mechanisms
underlying AF therapies.
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