ИСТИНА

Background: We simulated of paroxysmal (4-wave reentry) and persistent (6-wave reentry) atrial fibrillation (AFpa, AFpe) as a autowave processing in 2D active medium using scanning algorithm based on left atrial (LA) geometry as well as ablation (ABL) formatting, simulating ABL strategies. Objective: to estimate probability of 4- and 6-waves re-entry elimination due to simulation of ABL approaches in 2D modeling of LA and extrapolate this data to clinical results. Methods: Modeling of AF. Numeric reconstruction of the autowave process and the simulation of 4- and 6-wave re-entry were performed using Fitzhugh-Nagumo equation. We used mesh schema of direct lines in combination with scanning in MATLAB 7 for calculating in a 2D model of LA. Two ABL formatting (simulating clinical ABL strategies) were performed. Clinical data. Study was conducted on 40 pts with AFpa and AFpe. 1st group included 20 pts (51.4±13.6 years of age) with AFpa, who were divided into subgroup A (10 pts who underwent PVI using LASSO technique) and subgroup B (10 pts who underwent circumferential ABL combined with roof and mitral isthmus lines). 2nd group concluded 20 pts (58.2±10.6 years of age) with AFpe who underwent ABL the same strategy as a group 1B. We evaluated AF CL into the CS during ABL. Results. Modeling of AF. For 4-wave re-entry AFpa model there was no elimination of re-entry while circular LASSO-like ABL pattern was used. Linear ABL patterns (corresponding to linear ABL) suppress 4-wave re-entry. For AFpe model ABL formatting transformed 6- to 4-wave reentry. Clinical data. AF free were 80%/20% at 12 months in the 1st/2nd groups respectively (р=0,003). In the 2nd group organization of AF CL (from 112±24 to 204±35 ms) was verified in 12 of 20 pts. Conclusion: Non-patient personalized modeling of AF based on mathematical scanning approach may simulate AFpa and AFpe as 4- and 6-wave re-entry. Linear ABL modeling for 4-waves re-entry suppressed arrhythmia comparing to LASSO-like formatting. Linear ABL modeling for 6-waves re-entry transformed it to 4-wave re-entry. Results of ABL strategies modeling may consistent to clinical data.