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September 28, 2026Circulation Arrhythmia and Electrophysiology

Virtual Heart–Based Prediction of Ablation Outcomes in Persistent Atrial Fibrillation Based on Non–Pulmonary Vein Drivers

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Key result

Stable phase singularities in virtual heart models are linked to ~4.8-fold higher 1-year AF recurrence.

  • HR 5.78
  • 95% CI 2.18-15.3
  • P=0.002
  • n=165

Why the study?

Clinical outcomes of driver-targeted ablation in persistent atrial fibrillation have been inconsistent, highlighting the need for virtual heart-based approaches to characterize AF driver dynamics and guide ablation strategies.

Does virtual heart-based identification of stable phase singularities with stable dominant frequency predict AF recurrence in patients with persistent atrial fibrillation?

Population

165 patients with persistent atrial fibrillation from the CUVIA-AF2 study

Comparison

Virtual heart-based identification of stable phase singularities and dominant frequency dynamics at extra-pulmonary vein regions

Design

Cohort study using left atrial virtual heart models integrating cardiac CT and electroanatomical maps

Follow-up

1 year

Authors

THTaehyun HwangYonsei UniversityOKOh-Seok KwonYonsei UniversityJHJaeyeon HuhYonsei University

Discussion

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Implication

Stable phase singularities with stable dominant frequency were associated with higher AF recurrence; hypothesis-generating and requires prospective validation before guiding ablation.

Key Points

  • Determine whether electrophysiological features of extra-pulmonary vein drivers identified in virtual heart simulations can predict rhythm recurrence after catheter ablation in persistent atrial fibrillation.
  • Analyzed patient-specific left atrial virtual heart models combining cardiac computed tomography and electroanatomical mapping from 165 persistent atrial fibrillation patients in the CUVIA-AF2 study.
  • Conducted 34-second virtual simulations to assess stable phase singularities, dominant frequency stability across consecutive 6-second intervals, action potential duration restitution slopes via ramp pacing, and low-voltage areas (<0.5 mV) across 6 extra-pulmonary vein regions.
  • Stable phase singularities with stable dominant frequency occurred in 34.7% (43/124) of patients with extra-pulmonary vein drivers, displaying higher maximal action potential duration restitution slopes (1.41±0.80 vs 1.09±0.60; P <0.001) and greater local low-voltage burden (2.96±3.23% vs 2.10±2.75%) than meandering drivers.
  • Patients exhibiting stable phase singularities with stable dominant frequency experienced significantly higher 1-year arrhythmia recurrence (log-rank P=0.002; adjusted HR, 5.78 [95% CI, 2.18–15.3]), yielding an area under the curve of 0.765 for recurrence prediction.

Study Design

Type

Cohort (n=165)

Structured PICO

Does virtual heart-based identification of stable phase singularities with stable dominant frequency predict AF recurrence in patients with persistent atrial fibrillation?

P
Population
165 patients with persistent atrial fibrillation whose left atrial virtual heart models were analyzed for 1-year rhythm outcomes after ablation.
E
Exposure
Virtual heart-based identification of stable phase singularities (PS) and dominant frequency (DF) dynamics at extra-pulmonary vein regions
O
Outcome
Atrial fibrillation recurrence at 1-year follow-up

Main Result

Hazard Ratio: 5.78 (95% CI 2.18–15.3)

p-value: p=0.002

Virtual heart-based identification of stable phase singularities with stable dominant frequency is strongly associated with higher AF recurrence rates after ablation in persistent AF.

Limitations

  • Requires prospective validation

Cite This Study

Hwang et al. (2026) conducted a cohort in Persistent atrial fibrillation (AF) (n=165). Stable phase singularities (PS) with stable dominant frequency (DF) vs. Stable PS with meandering DF or absence of stable PS was evaluated on AF recurrence at 1-year follow-up (HR 5.78, 95% CI 2.18-15.3, p=0.002). Stable phase singularities with stable dominant frequency in virtual heart models were associated with higher AF recurrence at 1 year (adjusted HR 5.78; 95% CI 2.18-15.3; P=0.002).

synapsesocial.com/papers/6ab9b54a7822ec8fc3d8fd1bhttps://doi.org/10.1161/circep.125.014266

Topics

Atrial fibrillationPersistent AF managementAF ablation outcomesAnticoagulation in AF
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