Role of reverse remodelling in recurrence of atrial fibrillation after patient-tailored catheter ablation
George Teodor Obada, Shaheim Ogbomo-Harmitt, Maria Deprez, Nele Vandersickel, Oleg AslanidiAbstract
Background and aims
Catheter ablation (CA) is a curative treatment for atrial fibrillation (AF), yet success rates remain sub-optimal, with ∼50% of patients with persistent AF experiencing recurrence after 1 year. This may be due to the self-perpetuating nature of AF, which remodels atrial structure and cellular properties, while successful treatment can induce reverse remodelling (RR). This study develops a patient-specific CA strategy to directly target re-entrant drivers (RDs) and investigates the role of RR in AF recurrence.
Methods
Left atrial (LA) models were reconstructed from LGE-MRI scans of AF patients (n = 15) and coupled with the Courtemanche-Ramirez-Nattel (CRN) electrophysiology model. RDs were induced via pacing, identified using DGM analysis, and targeted ablation was performed in-silico. Pulmonary vein isolation (PVI) was applied as a reference. Following termination, AF recurrence was tested under three levels of electrical reverse remodelling (ERR: 0%, 50%, and 100%), with and without structural reverse remodelling (SRR).
Results
Targeted ablation acutely terminated AF in all patient-specific models. After the first procedure, AF recurrence decreased progressively from 55% at 0% ERR to 36.7% at 50% ERR and 5% at 100% ERR; with additional SRR, recurrence was further reduced to 46.7%, 26.7%, and 0%, respectively. After the second CA procedure, AF recurrence rate was 42.9%, 17.9%, and 0% without SRR and 25%, 14.3%, and 0% with SRR.
Conclusion
This study highlights the importance of RR for therapy success, with a novel targeted CA technique ensuring <5% AF recurrence in patient-specific simulations. After clinical validation, this approach can help improve long-term patient outcomes.