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Eur J Cardiothorac Surg 2007;32:90-95. doi:10.1016/j.ejcts.2007.02.031
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Use of a biophysical model of atrial fibrillation in the interpretation of the outcome of surgical ablation procedures

^a Department of Cardiovascular Surgery, University Hospital, Lausanne, Switzerland
^b Signal Processing Institute, École Polytechnique Fédérale de Lausanne, Switzerland
^c Department of Cardiology, University Hospital, Lausanne, Switzerland
^d Medtronic Europe, Tolochenaz, Switzerland

Received 5 September 2006; received in revised form 13 February 2007; accepted 20 February 2007.

^_* Corresponding author. Address: Service de Chirurgie Cardio-Vasculaire, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland. Tel.: + 41 21 314 2280; fax: + 41 21 314 2278. (Email: Patrick.Ruchat{at}chuv.hospvd.ch).

Objective: To determine the adequacy of ‘in silico’ biophysical models of atrial fibrillation (AF) in the design of different ablation line patterns. Background: Permanent AF is a severe medical problem for which (surgical) ablation is a possible treatment. The ideal ablation pattern remains to be defined. Methods: Forty-six consecutive adult patients with symptomatic permanent drug refractory AF underwent mitral surgery combined with non-transmural, (n = 20) and transmural (n = 26) radiofrequency Minimaze. The fraction of ‘in vivo’ conversions to sinus rhythm (SR) in both groups was compared with the performance of the fraction of ‘in silico’ conversions observed in a biophysical model of permanent AF. The simulations allowed us to study the effectiveness of incomplete and complete ablation patterns. A simulated, complete, transmural Maze III ablation pattern was applied to 118 different episodes of simulated AF set-up in the model and its effectiveness was compared with the clinical results reported by Cox. Results: The fraction of conversions to SR was 92% ‘in vivo’ and 88% ‘in silico’ (p = ns) for transmural/complete ablations, 60% respectively 65% for non-transmural/incomplete Minimaze (p = ns) and 98% respectively 100% for Maze III ablations (p = ns). The fraction of conversions to SR ‘in silico’ correlated with the rates ‘in vivo’ (r ² = 0.973). Conclusions: The fraction of conversions to SR observed in the model closely corresponded to the conversion rate to SR post-surgery. This suggests that the model provides an additional, non-invasive tool for optimizing ablation line patterns for treating permanent AF.

Abbreviations: AF = atrial fibrillation • AFL = atrial flutter • SR = sinus rhythm • RF = radiofrequency • APD = action potential duration • TAFT = time to atrial fibrillation termination • MV = mitral valve • DV = double (aortic and mitral) valve • TV = tricuspid valve • IVC = inferior vena cava • CPB = cardiopulmonary bypass • ACC = aortic cross clamping • LAA = left atrial appendage • RAA = right atrial appendage

Key Words: Atrium • Fibrillation • Ablation • Surgery • Biophysical modeling

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