Functional digital twins of the atria based on intracardiac measurements

Atrial fibrillation (AF) remains the most prevalent sustained arrhythmia globally, partly because patient-specific mechanisms are still not fully assessable. To address this, we present an automated digital twin pipeline that transforms clinical electro-anatomical mapping data into personalized, simulation-ready atrial models. This pipeline allows assessing reentry vulnerability and the effect of arbitrary ablation patterns to support clinical decision-making and individualized ablation planning.

Beyond anatomical personalization, our approach integrates two key functional electrophysiological parameters: local activation times (LATs) and effective refractory periods (ERPs). LAT maps are used to infer spatially resolved conduction velocities (CVs) and their anisotropy, while ERP measurements personalize local cellular excitability. Together, these parameters define the excitable gap—a critical determinant of AF vulnerability.

To ensure physiological accuracy, LATs are processed using a robust segment-based filtering method that accurately represents pathological conduction patterns while eliminating noise and outliers. Conductivities are then tuned per segment based on these refined LATs. In parallel, ERP measurements—determined via intra-atrial stimulation—are incorporated using established personalization algorithms to adjust conductances of cell membrane ion channels locally.

This dual-modality personalization is embedded in a streamlined, automated pipeline for model generation within clinical timeframes. The pipeline was validated in a prospective clinical study involving 30 patients with recurrent AF post-pulmonary vein isolation. Each patient underwent comprehensive left atrial mapping and ERP recording, enabling the reconstruction of anisotropic conduction properties and spatially distributed ERP profiles.

The resulting digital twins are used to simulate AF inducibility and explore patient-specific arrhythmogenic mechanisms. Ultimately, this pipeline lays the foundation for real-time, bedside deployment of digital twin technology in electrophysiology labs, enabling personalized therapy planning for improved clinical outcomes.

Pipeline for digital twin creation