Assessing the arrhythmogenic propensity of fibrotic substrate using digital twins to inform a mechanisms-based atrial fibrillation ablation strategy

Kensuke Sakata, Ryan P. Bradley, Adityo Prakosa, Carolyna A.P. Yamamoto, Syed Yusuf Ali, Shane Loeffler, Brock M. Tice, Patrick M. Boyle, Eugene G. Kholmovski, Ritu Yadav, Sunil Kumar Sinha, Joseph E. Marine, Hugh Calkins, David D. Spragg, Natalia A. Trayanova

Research output: Contribution to journalArticlepeer-review

Abstract

Atrial fibrillation (AF), the most common heart rhythm disorder, may cause stroke and heart failure. For patients with persistent AF with fibrosis proliferation, the standard AF treatment—pulmonary vein isolation—has poor outcomes, necessitating redo procedures, owing to insufficient understanding of what constitutes good targets in fibrotic substrates. Here we present a prospective clinical and personalized digital twin study that characterizes the arrhythmogenic properties of persistent AF substrates and uncovers locations possessing rotor-attracting capabilities. Among these, a portion needs to be ablated to render the substrate not inducible for rotors, but the rest (37%) lose rotor-attracting capabilities when another location is ablated. Leveraging digital twin mechanistic insights, we suggest ablation targets that eliminate arrhythmia propensity with minimum lesions while also minimizing the risk of iatrogenic tachycardia and AF recurrence. Our findings provide further evidence regarding the appropriate substrate ablation targets in persistent AF, opening the door for effective strategies to mitigate patients’ AF burden.

Original languageEnglish (US)
Pages (from-to)857-868
Number of pages12
JournalNature Cardiovascular Research
Volume3
Issue number7
DOIs
StatePublished - Jul 2024

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology (miscellaneous)
  • Cell Biology
  • Medicine (miscellaneous)
  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Assessing the arrhythmogenic propensity of fibrotic substrate using digital twins to inform a mechanisms-based atrial fibrillation ablation strategy'. Together they form a unique fingerprint.

Cite this