Clinical application of virtual antiarrhythmic drug test using digital twins in patients who recurred atrial fibrillation after catheter ablation

Abstract Funding Acknowledgements Type of funding sources: None. Background We previously reported a proof-of-concept study that digital twins can test antiarrhythmic drug (AAD) effects on atrial fibrillation (AF) after integrating the patients’ cardiac CT imaging and electroanatomical map (EAM). In this study, we evaluated reproducibility virtual AAD (V-AAD) in clinical setting patients who recurred AF catheter ablation (AFCA) took AADs. Methods This single-center retrospective included 232 (71.6% male, 60.5±10.2 years age, 40.9% paroxysmal AF) were prescribed AADs AFCA due to real or high chance recurrence. Clinical (C-AAD) chosen at discretion primary care physician blinded V-AAD test. All those underwent using reflecting anatomy, histology, electrophysiology by EAM. The ion currents for each (amiodarone, sotalol, dronedarone, flecainide, propafenone; 2 doses drug) defined based previous publications. most efficient as terminated fastest. association between recurrence rate while C-AAD V-AAD, which showed excellent termination/ defragmentation twins. Results setting, effective was administered 72 (31.0%), not V-AADs 61 (26.3%). During median 782 (IQR 582-1047) days follow-up, observed 132 (56.9%) (under class IC 44.4% III 57.4%). within year 40.9%, ineffective 54.1%, respectively (log-rank p=0.046). with ≥2 0 1 42.4% 59.3%, p=0.056). Conclusions twins-guided feasible evaluating efficacy multiple AFCA. need prospective randomization evaluate prediction power