Patient-Specific Atrial Fibrillation Simulation Prediction Depend on Rhythm Used for Calibration

Personalised therapies using patient-specific models of atrial fibrillation (AF) can enhance treatment outcomes. Electroanatomic data collected during an ablation procedure can be used to calibrate patient-specific activation and repolarisation properties, which affect AF properties and therapy outcomes. However, it is unknown how calibration data rhythm, pacing location, and choice of calibration technique affects prediction. In this study, we aim to compare AF properties and predicted therapy responses for patient-specific models calibrated using electroanatomic mapping data collected at different pacing rates. Initially, six patients underwent electroanatomic mapping during catheter ablation therapy, with pacing from a catheter in the coronary sinus at cycle lengths of 250ms and 600ms. Personalised anatomical models were constructed and calibrated to conduction velocity maps at each of the pacing rates. Simulations of AF were performed and pulmonary vein isolation was applied. Across the simulation models, all of the 6 cases had a greater number of occurrences of rotational activity for the models calibrated to 250ms than models calibrated to 600ms. This was most evident in the inferior wall, which had an average of 1.33 number of occurrences per patient at 250ms and an average of 0.17 number of occurrences per patient at 600ms. Thus, AF properties depend on the pacing rate used for model calibration.