Speaker
Description
Background:
High-power radiofrequency ablation (HP-RFA) is a minimally invasive technique for treating atrial fibrillation (AF); pulmonary vein isolation (PVI) serves as the cornerstone of this treatment. Variations in patient characteristics, such as body mass index (BMI), can influence the effectiveness and safety of PVI procedures. Obesity is a growing concern in the population, and its impact on cardiac interventions, including PVI, remains an area of ongoing research.
Methods:
We developed virtual patient models from CT scans by performing detailed segmentation, incorporating anatomical structures such as the heart, lungs, liver, fat, and muscle, among others. We used three virtual patients, one for each of the following BMI groups: normal weight (less than 25 kg/ m^2), pre-obesity (between 25 kg/ m\squared} and 30 kg/ m^2), and morbid obesity (more than 35 kg/m^2).
Electrodes were placed at four locations on the left atrial wall near each of the pulmonary vein. A dispersive patch at the back of each virtual patient completed the circuit. The power distribution in the ablation procedure was simulated using a high-power protocol set at 90 W.
Results: The virtual patients models showed significant BMI-related variations in anatomical structures, particularly fat and muscle distribution, which impacted power delivery. In morbidly obese patients, increased fat tissue caused higher impedance with respect to normal weight patients. Despite these variations, small differences were observed in the dissipated power within the left atrial tissue. All patients showed consistently higher tissue power dissipation for thicker tissues and more specifically at the right superior pulmonary vein. However, this trend was only observed per patient, as obese patients feature lower tissue power dissipation than normal weight ones for the same wall thickness.
Discussion:
Our study demonstrates the feasibility of using computational modeling to analyze how BMI affects PVI procedures. We found that variations in body composition influence the total impedance and the dissipated tissue power at patients featuring the same wall thickness. These insights highlight the potential for personalized treatment strategies to improve the effectiveness and safety of cardiac interventions, particularly for individuals with higher BMI.
Affiliation
RICAM linz austria