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  • Joung, Boyoung  (9)
  • Lim, Byounghyun  (9)
  • 1
    Online Resource
    Online Resource
    Clinical Usefulness of Virtual Ablation Guided Catheter Ablation of Atrial Fibrillation Targeting Restitution Parameter-Guided Catheter Ablation: CUVIA-REGAB Prospective Randomized Study
    XMLink ; 2022
    In:  Korean Circulation Journal Vol. 52, No. 9 ( 2022), p. 699-
    Details
    In: Korean Circulation Journal, XMLink, Vol. 52, No. 9 ( 2022), p. 699-
    Type of Medium: Online Resource
    ISSN: 1738-5520 , 1738-5555
    URL: Article
    DOI: 10.4070/kcj.2022.0113
    Language: English
    Publisher: XMLink
    Publication Date: 2022
    detail.hit.zdb_id: 2528698-5
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  • 2
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    Table_1.docx
    Frontiers Media SA ; 2022
    In:  Frontiers in Cardiovascular Medicine Vol. 9 ( 2022-3-3)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 9 ( 2022-3-3)
    Abstract: Although the dominant frequency (DF) localizes the reentrant drivers and the maximal slope of the action potential duration (APD) restitution curve (Smax) reflects the tendency of the wave-break, their interaction has never been studied. We hypothesized that DF ablation has different effects on atrial fibrillation (AF) depending on Smax. Methods We studied the DF and Smax in 25 realistic human persistent AF model samples (68% male, 60 ± 10 years old). Virtual AF was induced by ramp pacing measuring Smax, followed by spatiotemporal DF evaluation for 34 s. We assessed the DF ablation effect depending on Smax in both computational modeling and a previous clinical trial, CUVIA-AF (170 patients with persistent AF, 70.6% male, 60 ± 11 years old). Results Mean DF had an inverse relationship with Smax regardless of AF acquisition timing ( p & lt; 0.001). Virtual DF ablations increased the defragmentation rate compared to pulmonary vein isolation (PVI) alone ( p = 0.015), especially at Smax & lt;1 (61.5 vs. 7.7%, p = 0.011). In post-DF ablation defragmentation episodes, DF was significantly higher ( p = 0.002), and Smax was lower ( p = 0.003) than in episodes without defragmentation. In the post-hoc analysis of CUVIA-AF2, we replicated the inverse relationship between Smax and DF ( r = −0.47, p & lt; 0.001), and we observed better rhythm outcomes of clinical DF ablations in addition to a PVI than of empirical PVI at Smax & lt;1 [hazard ratio 0.45, 95% CI (0.22–0.89), p = 0.022; log-rank p = 0.021] but not at ≥ 1 (log-rank p = 0.177). Conclusion We found an inverse relationship between DF and Smax and the outcome of DF ablation after PVI was superior at the condition with Smax & lt;1 in both in-silico and clinical trials.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2022.838646
    DOI: 10.3389/fcvm.2022.838646.s001
    DOI: 10.3389/fcvm.2022.838646.s002
    DOI: 10.3389/fcvm.2022.838646.s003
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 3
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    DataSheet1.docx
    Frontiers Media SA ; 2022
    In:  Frontiers in Physiology Vol. 13 ( 2022-12-2)
    Details
    In: Frontiers in Physiology, Frontiers Media SA, Vol. 13 ( 2022-12-2)
    Type of Medium: Online Resource
    ISSN: 1664-042X
    URL: Article
    URL: Article
    DOI: 10.3389/fphys.2022.991997
    DOI: 10.3389/fphys.2022.991997.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 4
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    Data_Sheet_1.docx
    Frontiers Media SA ; 2021
    In:  Frontiers in Cardiovascular Medicine Vol. 8 ( 2021-12-8)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 8 ( 2021-12-8)
    Abstract: Background: Clinical recurrence after atrial fibrillation catheter ablation (AFCA) still remains high in patients with persistent AF (PeAF). We investigated whether an extra-pulmonary vein (PV) ablation targeting the dominant frequency (DF) extracted from electroanatomical map–integrated AF computational modeling improves the AFCA rhythm outcome in patients with PeAF. Methods: In this open-label, randomized, multi-center, controlled trial, 170 patients with PeAF were randomized at a 1:1 ratio to the computational modeling-guided virtual DF (V-DF) ablation and empirical PV isolation (E-PVI) groups. We generated a virtual dominant frequency (DF) map based on the atrial substrate map obtained during the clinical AF ablation procedure using computational modeling. This simulation was possible within the time of the PVI procedure. V-DF group underwent extra-PV V-DF ablation in addition to PVI, but DF information was not notified to the operators from the core lab in the E-PVI group. Results: After a mean follow-up period of 16.3 ± 5.3 months, the clinical recurrence rate was significantly lower in the V-DF than with E-PVI group ( P = 0.018, log-rank). Recurrences appearing as atrial tachycardias ( P = 0.145) and the cardioversion rates ( P = 0.362) did not significantly differ between the groups. At the final follow-up, sinus rhythm was maintained without any AADs in 74.7% in the V-DF group and 48.2% in the E-PVI group ( P & lt; 0.001). No significant difference was found in the major complication rates ( P = 0.489) or total procedure time ( P = 0.513) between the groups. The V-DF ablation was independently associated with a reduced AF recurrence after AFCA [hazard ratio: 0.51 (95% confidence interval: 0.30–0.88); P = 0.016]. Conclusions: The computational modeling-guided V-DF ablation improved the rhythm outcome of AFCA in patients with PeAF. Clinical Trial Registration: Clinical Research Information Service, CRIS identifier: KCT0003613.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2021.772665
    DOI: 10.3389/fcvm.2021.772665.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
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  • 5
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    Image_3.TIF
    Frontiers Media SA ; 2021
    In:  Frontiers in Physiology Vol. 12 ( 2021-9-24)
    Details
    In: Frontiers in Physiology, Frontiers Media SA, Vol. 12 ( 2021-9-24)
    Abstract: Background: We previously reported that a computational modeling-guided antiarrhythmic drug (AAD) test was feasible for evaluating multiple AADs in patients with atrial fibrillation (AF). We explored the anti-AF mechanisms of AADs and spatial change in the AF wave-dynamics by a realistic computational model. Methods: We used realistic computational modeling of 25 AF patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal AF) reflecting the anatomy, histology, and electrophysiology of the left atrium (LA) to characterize the effects of five AADs (amiodarone, sotalol, dronedarone, flecainide, and propafenone). We evaluated the spatial change in the AF wave-dynamics by measuring the mean dominant frequency (DF) and its coefficient of variation [dominant frequency-coefficient of variation (DF-COV)] in 10 segments of the LA. The mean DF and DF-COV were compared according to the pulmonary vein (PV) vs. extra-PV, maximal slope of the restitution curves (Smax), and defragmentation of AF. Results: The mean DF decreased after the administration of AADs in the dose dependent manner ( p & lt; 0.001). Under AADs, the DF was significantly lower ( p & lt; 0.001) and COV-DF higher ( p = 0.003) in the PV than extra-PV region. The mean DF was significantly lower at a high Smax (≥1.4) than a lower Smax condition under AADs. During the episodes of AF defragmentation, the mean DF was lower ( p & lt; 0.001), but the COV-DF was higher ( p & lt; 0.001) than that in those without defragmentation. Conclusions: The DF reduction with AADs is predominant in the PVs and during a high Smax condition and causes AF termination or defragmentation during a lower DF and spatially unstable (higher DF-COV) condition.
    Type of Medium: Online Resource
    ISSN: 1664-042X
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fphys.2021.733543
    DOI: 10.3389/fphys.2021.733543.s001
    DOI: 10.3389/fphys.2021.733543.s002
    DOI: 10.3389/fphys.2021.733543.s003
    DOI: 10.3389/fphys.2021.733543.s004
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
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  • 6
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    DataSheet1.docx
    Frontiers Media SA ; 2022
    In:  Frontiers in Physiology Vol. 13 ( 2022-12-15)
    Details
    In: Frontiers in Physiology, Frontiers Media SA, Vol. 13 ( 2022-12-15)
    Type of Medium: Online Resource
    ISSN: 1664-042X
    URL: Article
    URL: Article
    DOI: 10.3389/fphys.2022.992000
    DOI: 10.3389/fphys.2022.992000.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 7
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    Image_4.TIF
    Frontiers Media SA ; 2021
    In:  Frontiers in Physiology Vol. 12 ( 2021-5-13)
    Details
    In: Frontiers in Physiology, Frontiers Media SA, Vol. 12 ( 2021-5-13)
    Abstract: Background: The efficacy of antiarrhythmic drugs (AAD) can vary in patients with atrial fibrillation (AF), and the PITX2 gene affects the responsiveness of AADs. We explored the virtual AAD (V-AAD) responses between wild-type and PITX2 +/− -deficient AF conditions by realistic in silico AF modeling. Methods: We tested the V-AADs in AF modeling integrated with patients' 3D-computed tomography and 3D-electroanatomical mapping, acquired in 25 patients (68% male, 59.8 ± 9.8 years old, 32.0% paroxysmal type). The ion currents for the PITX2 +/− deficiency and each AAD (amiodarone, sotalol, dronedarone, flecainide, and propafenone) were defined based on previous publications. Results: We compared the wild-type and PITX2 +/− deficiency in terms of the action potential duration (APD 90 ), conduction velocity (CV), maximal slope of restitution (Smax), and wave-dynamic parameters, such as the dominant frequency (DF), phase singularities (PS), and AF termination rates according to the V-AADs. The PITX2 +/− -deficient model exhibited a shorter APD 90 ( p & lt; 0.001), a lower Smax ( p & lt; 0.001), mean DF ( p = 0.012), PS number ( p & lt; 0.001), and a longer AF cycle length (AFCL, p = 0.011). Five V-AADs changed the electrophysiology in a dose-dependent manner. AAD-induced AFCL lengthening ( p & lt; 0.001) and reductions in the CV ( p = 0.033), peak DF ( p & lt; 0.001), and PS number ( p & lt; 0.001) were more significant in PITX2 +/− -deficient than wild-type AF. PITX2 +/− -deficient AF was easier to terminate with class IC AADs than the wild-type AF ( p = 0.018). Conclusions: The computational modeling-guided AAD test was feasible for evaluating the efficacy of multiple AADs in patients with AF. AF wave-dynamic and electrophysiological characteristics are different among the PITX2 -deficient and the wild-type genotype models.
    Type of Medium: Online Resource
    ISSN: 1664-042X
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fphys.2021.650449
    DOI: 10.3389/fphys.2021.650449.s001
    DOI: 10.3389/fphys.2021.650449.s002
    DOI: 10.3389/fphys.2021.650449.s003
    DOI: 10.3389/fphys.2021.650449.s004
    DOI: 10.3389/fphys.2021.650449.s005
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2021
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  • 8
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    Image_1.jpeg
    Frontiers Media SA ; 2022
    In:  Frontiers in Cardiovascular Medicine Vol. 9 ( 2022-7-19)
    Details
    In: Frontiers in Cardiovascular Medicine, Frontiers Media SA, Vol. 9 ( 2022-7-19)
    Abstract: Atrial fibrillation (AF) is a heritable disease, and the paired-like homeodomain transcription factor 2 ( PITX2 ) gene is highly associated with AF. We explored the differences in the circumferential pulmonary vein isolation (CPVI), which is the cornerstone procedure for AF catheter ablation, additional high dominant frequency (DF) site ablation, and antiarrhythmic drug (AAD) effects according to the patient genotype (wild-type and PITX2 +/− deficient) using computational modeling. Methods We included 25 patients with AF (68% men, 59.8 ± 9.8 years of age, 32% paroxysmal AF) who underwent AF catheter ablation to develop a realistic computational AF model. The ion currents for baseline AF and the amiodarone, dronedarone, and flecainide AADs according to the patient genotype (wild type and PITX2 +/− deficient) were defined by relevant publications. We tested the virtual CPVI (V-CPVI) with and without DF ablation (±DFA) and three virtual AADs (V-AADs, amiodarone, dronedarone, and flecainide) and evaluated the AF defragmentation rates (AF termination or changes to regular atrial tachycardia (AT), DF, and maximal slope of the action potential duration restitution curves (Smax), which indicates the vulnerability of wave-breaks. Results At the baseline AF, mean DF ( p = 0.003), and Smax ( p & lt; 0.001) were significantly lower in PITX2 +/− deficient patients than wild-type patients. In the overall AF episodes, V-CPVI (±DFA) resulted in a higher AF defragmentation relative to V-AADs (65 vs. 42%, p & lt; 0.001) without changing the DF or Smax. Although a PITX2 +/− deficiency did not affect the AF defragmentation rate after the V-CPVI (±DFA), V-AADs had a higher AF defragmentation rate ( p = 0.014), lower DF ( p & lt; 0.001), and lower Smax ( p = 0.001) in PITX2 +/− deficient AF than in wild-type patients. In the clinical setting, the PITX2 +/− genetic risk score did not affect the AF ablation rhythm outcome (Log-rank p = 0.273). Conclusion Consistent with previous clinical studies, the V-CPVI had effective anti-AF effects regardless of the PITX2 genotype, whereas V-AADs exhibited more significant defragmentation or wave-dynamic change in the PITX2 +/− deficient patients.
    Type of Medium: Online Resource
    ISSN: 2297-055X
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.3389/fcvm.2022.942998
    DOI: 10.3389/fcvm.2022.942998.s001
    DOI: 10.3389/fcvm.2022.942998.s002
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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  • 9
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    Table_1.DOCX
    Frontiers Media SA ; 2022
    In:  Frontiers in Physiology Vol. 13 ( 2022-3-17)
    Details
    In: Frontiers in Physiology, Frontiers Media SA, Vol. 13 ( 2022-3-17)
    Abstract: Although pulmonary vein isolation (PVI) gaps contribute to recurrence after atrial fibrillation (AF) catheter ablation, the mechanism is unclear. We used realistic computational human AF modeling to explore the AF wave-dynamic changes of PVI with gaps (PVI-gaps). Methods We included 40 patients (80% male, 61.0 ± 9.8 years old, 92.5% persistent AF) who underwent AF catheter ablation to develop our realistic computational AF model. We compared the effects of a complete PVI (CPVI) and PVI-gap (2-mm × 4) on the AF wave-dynamics by evaluating the dominant frequency (DF), spatial change of DF, maximal slope of the action potential duration restitution curve (Smax), and AF defragmentation rate (termination or change to atrial tachycardia), and tested the effects of additional virtual interventions and flecainide on ongoing AF with PVI-gaps. Results Compared with the baseline AF, CPVIs significantly reduced extra-PV DFs ( p   & lt; 0.001), but PVI-gaps did not. COV-DFs were greater after CPVIs than PVI-gaps ( p   & lt; 0.001). Neither CPVIs nor PVI-gaps changed the mean Smax. CPVIs resulted in higher AF defragmentation rates (80%) than PVI-gaps (12.5%, p   & lt; 0.001). In ongoing AF after PVI-gaps, the AF defragmentation rates after a wave-breaking gap ablation, extra-PV DF ablation, or flecainide were 60.0, 34.3, and 25.7%, respectively ( p  = 0.010). Conclusion CPVIs effectively reduced the DF, increased its spatial heterogeneity in extra-PV areas, and offered better anti-AF effects than extra-PV DF ablation or additional flecainide in PVI-gap conditions.
    Type of Medium: Online Resource
    ISSN: 1664-042X
    URL: Article
    URL: Article
    DOI: 10.3389/fphys.2022.846620
    DOI: 10.3389/fphys.2022.846620.s001
    Language: Unknown
    Publisher: Frontiers Media SA
    Publication Date: 2022
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