Arrhythmogenic substrates in atrial fibrillation and the role of ablation lesions: a longitudinal biatrial digital twin study

作者：Carolyna Yamamoto, Kensuke Sakata, Syed Yusuf Ali, Shane Loeffler, Adityo Prakosa, Brock M. Tice, Eugene G Kholmovski, Natalia A. Trayanova · 发表于：Cardiovascular Research · 年份：2026 · DOI：10.1093/cvr/cvag016 · 被引用次数：3 · 研究领域：Atrial Fibrillation Management and Outcomes、Cardiac Arrhythmias and Treatments、Cardiac electrophysiology and arrhythmias

AIMS: Arrhythmogenic fibrotic substrates facilitate reentrant activity in the atria, contributing to the perpetuation of atrial fibrillation (AF). Catheter ablation may disrupt existing reentrant pathways but can also create new ones. This longitudinal study aimed to assess whether post-ablation AF recurrence is associated with incomplete elimination of native arrhythmogenic substrates or emergence of new arrhythmogenic substrates created by ablation lesions, addressing important questions in current AF management: why some patients experience recurrence post-ablation while others do not, and whether ablation lesions themselves contribute to post-ablation arrhythmogenesis. METHODS AND RESULTS: Biatrial digital twins (DTs) derived from pre- and post-ablation contrast-enhanced magnetic resonance imaging were used to evaluate the arrhythmogenic propensity of the fibrotic substrate-quantified by potential reentry-sites (PRs) and a vulnerability index (VI) reflecting reentry inducibility. Pre- and post-ablation DT pairs were generated for 11 patients who experienced AF recurrence (R-DTs) and 11 who did not (N-DTs). In total, 58 pre-ablation PRs and 32 post-ablation PRs were detected, with a nearly even distribution of PRs between the left atrium (LA) and right atrium (RA) both pre- and post-ablation. Pre-ablation VI was similar between N-DTs and R-DTs; however, post-ablation VI was significantly higher in R-DTs (P = 0.015). N-DTs exhibited a marked reduction in PRs following ablat...