Key result
In-silico electrical reverse remodelling cuts post-ablation AF recurrence by ~50 percentage points.
Why the study?
Catheter ablation success rates for persistent AF remain sub-optimal, with approximately 50% of patients experiencing recurrence after 1 year, potentially due to AF-induced atrial remodelling. This study developed a patient-specific ablation strategy targeting re-entrant drivers and investigated the role of reverse remodelling in AF recurrence.
Does in-silico patient-specific targeted catheter ablation combined with electrical and structural reverse remodelling reduce atrial fibrillation recurrence in patient-specific left atrial models?
Does in-silico patient-specific targeted catheter ablation combined with electrical and structural reverse remodelling reduce atrial fibrillation recurrence in patient-specific left atrial models?
In-silico modeling demonstrates that combining patient-tailored catheter ablation targeting re-entrant drivers with electrical and structural reverse remodelling markedly reduces simulated atrial fibrillation recurrence to less than 5%.
Answers are grounded in this paper and cite their sources.
Targeted ablation yields high recurrence in this small series; leaves open its role versus standard approaches in persistent AF.
BACKGROUND AND AIMS: Catheter ablation (CA) is a curative treatment for atrial fibrillation (AF), yet success rates remain sub-optimal, with ∼50% of patients with persistent AF experiencing recurrence after 1 year. This may be due to the self-perpetuating nature of AF, which remodels atrial structure and cellular properties, while successful treatment can induce reverse remodelling (RR). This study develops a patient-specific CA strategy to directly target re-entrant drivers (RDs) and investigates the role of RR in AF recurrence. METHODS: Left atrial (LA) models were reconstructed from LGE-MRI scans of AF patients (n = 15) and coupled with the Courtemanche-Ramirez-Nattel (CRN) electrophysiology model. RDs were induced via pacing, identified using DGM analysis, and targeted ablation was performed in-silico. Pulmonary vein isolation (PVI) was applied as a reference. Following termination, AF recurrence was tested under three levels of electrical reverse remodelling (ERR: 0%, 50%, and 100%), with and without structural reverse remodelling (SRR). RESULTS: Targeted ablation acutely terminated AF in all patient-specific models. After the first procedure, AF recurrence decreased progressively from 55% at 0% ERR to 36.7% at 50% ERR and 5% at 100% ERR; with additional SRR, recurrence was further reduced to 46.7%, 26.7%, and 0%, respectively. After the second CA procedure, AF recurrence rate was 42.9%, 17.9%, and 0% without SRR and 25%, 14.3%, and 0% with SRR. CONCLUSION: This study highlights the importance of RR for therapy success, with a novel targeted CA technique ensuring <5% AF recurrence in patient-specific simulations. After clinical validation, this approach can help improve long-term patient outcomes.
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Aslanidi et al. (2026) studied Atrial fibrillation (n=15). In-silico targeted catheter ablation of re-entrant drivers with electrical and structural reverse remodelling vs. Pulmonary vein isolation (PVI) / 0% electrical reverse remodelling without structural reverse remodelling was evaluated on Atrial fibrillation recurrence after first procedure (100% vs 0% electrical reverse remodelling without structural reverse remodelling). In-silico targeted catheter ablation with 100% electrical reverse remodelling reduced AF recurrence from 55% (at 0% ERR) to 5%, and to 0% with structural reverse remodelling.
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