Ablation strategies that target AF sources beyond pulmonary vein isolation may improve outcomes in persistent AF. A digital-twin analysis published in EP Europace evaluated a novel EOF-guided ablation strategy designed to prioritize patient-specific targets while limiting the amount of atrial tissue ablated.

The study used a virtual cohort of 250 bi-atrial digital twins with varying atrial fibrosis distributions. Five AF episodes were simulated per case following PVI. Phase singularity (PS) maps and average optical flow maps were generated. Regions overlapping in at least three binarized PS maps were defined as concordant areas. Within these regions, optical curl was used to identify five EOF target centroids for ablation. Six ablation strategies were simulated, and efficacy was assessed using an inducibility-to-ablated-tissue-area metric.

EOF-guided ablation resulted in an average AF inducibility of 32 ± 2%. In comparison, PVI alone showed 90 ± 5% inducibility, and PVI with empiric ablation targets showed 87 ± 6%. A consensus EOF strategy further reduced inducibility to 20 ± 5% and spared 28 ± 2% more atrial tissue compared with PVI plus PS ablation.

These results demonstrate that EOF-guided ablation planning can reduce AF inducibility more effectively than conventional strategies in a digital-twin model while limiting atrial tissue ablation.