Circulation. Arrhythmia and electrophysiology最新文献

{"title":"Cryoballoon Roof Line and Pulmonary Vein Isolation for Persistent Atrial Fibrillation: A Randomized Trial.","authors":"Changjin Li, Yao Zhao, Ruihan Ju, Chao Liu, Shaohua Dong, Jingwen Song, Aihong Qin, Jiang Cao, Manli Yu, Xinmiao Huang, Zhifu Guo, Songqun Huang","doi":"10.1161/CIRCEP.125.013826","DOIUrl":"10.1161/CIRCEP.125.013826","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013826"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility and Safety of Pulsed Field Ablation for Coronary Sinus and Left Atrial Appendage Isolation and Mitral Isthmus Ablation: Acute and Chronic Findings.","authors":"Vincenzo Mirco La Fazia, Sanghamitra Mohanty, Carola Gianni, Elio Zito, Nicola Pierucci, Giuseppe Stifano, Preem Geeta Torlapati, Domenico G Della Rocca, Weeranun Dechyapirom Bode, J David Burkhardt, Rodney Horton, Amin Al-Ahmad, Luigi Di Biase, Andrea Natale","doi":"10.1161/CIRCEP.125.014026","DOIUrl":"10.1161/CIRCEP.125.014026","url":null,"abstract":"<p><strong>Background: </strong>The safety and efficacy of pulsed field ablation for pulmonary vein and posterior wall isolation in atrial fibrillation ablation are well established; however, evidence regarding its use in extra-pulmonary vein areas remains limited. The aim of this study was to assess the feasibility and durability of pulsed field ablation for coronary sinus (CS) and left atrial appendage (LAA) isolation and mitral isthmus (MI) ablation.</p><p><strong>Methods: </strong>We analyzed data from consecutive patients who underwent repeat atrial fibrillation ablation with pulsed field ablation between February and October 2024. MI ablation, CS isolation, and LAA isolation were attempted in all patients using the Farapulse (Boston Scientific) ablation system. Acute isolation was assessed after a 20-minute waiting period and an adenosine challenge, while chronic durability was evaluated during a repeat procedure for LAA closure at 3 months.</p><p><strong>Results: </strong>A total of 236 patients (145, 61.4% men) were included in our analysis. Acute CS isolation was achieved in 147 (62.2%) patients for the CS and in all patients for the LAA. Acute MI block was obtained in all patients. After a 20-minute waiting time, the adenosine challenge revealed dormant conduction in 52 (26.4%) cases for the CS, in 4 (1.7%) for the LAA, and MI block regression in 35 (14.8%). All patients underwent remapping at the time of left atrial appendage occlusion, which showed CS and LAA isolation in only 3 (1.3%) and 10 (4.6%) patients, respectively, and MI block in 13 (5.5%) cases.</p><p><strong>Conclusions: </strong>Pulsed field ablation is a feasible and acutely effective method for CS and LAA isolation and MI block; however, lesion durability remains a significant limitation.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014026"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Role of the Noninvasive Abdominal Fetal ECG in the Detection and Monitoring of Fetal Tachycardia.","authors":"Sian Chivers, Nicolò Pini, Shayan Chowdhury, Ludovica Cicci, Trisha Vigneswaran, Vita Zidere, Sophie Maxwell, Grace Moriarty, William Regan, Eric Rosenthal, David F A Lloyd, Thomas G Day, Owen I Miller, Gurleen K Sharland, Barrie Hayes-Gill, Stephen Niederer, William P Fifer, Catherine Williamson, John M Simpson","doi":"10.1161/CIRCEP.124.013556","DOIUrl":"10.1161/CIRCEP.124.013556","url":null,"abstract":"<p><strong>Background: </strong>Fetal tachycardias can cause adverse fetal outcomes including ventricular dysfunction, hydrops, and fetal demise. Postnatally, ECG is the gold standard, but, in fetal practice, echocardiography is used most frequently to diagnose and monitor fetal arrhythmias. Noninvasive extraction of the fetal ECG (fECG) may provide additional information about the electrophysiological mechanism and monitoring of intermittent arrhythmias. Signal processing advances could provide improved data quality impacting clinical translation. The aim of this study was to assess the fetus with known or suspected tachycardia using noninvasive abdominal fECG and correlate results with fetal echocardiography and postnatal ECG.</p><p><strong>Methods: </strong>Prospective recruitment of pregnant participants with known or suspected fetal tachycardia in a tertiary fetal cardiology unit. Overnight fECG recording at home using the MonicaAN24 monitor was performed. Data processing using bespoke MATLAB scripts was undertaken to produce fetal heart rate and beat-to-beat rhythm strips. Comparison of fECG data with clinical data obtained using echocardiography and postnatal findings. Data are presented as median (interquartile range; range).</p><p><strong>Results: </strong>Fifteen participants undertook 1 to 4 fECG recordings, giving a total of 23 recordings. Gestational age was 28.9 (23.9-34.3; 21-39.1) weeks. Duration of recording was 512 (380-609; 5-1259) minutes. Intermittent tachycardia was demonstrated on fetal heart rate graphs. Rhythm strips correctly identified short-ventriculoatrial and long-ventriculoatrial tachycardia, atrial flutter, and sinus rhythm with findings correlating with echocardiography. Postnatal ECG correlation was possible in 3.</p><p><strong>Conclusions: </strong>We have shown that rhythm strips of fECG signals can be extracted and correctly identify the electrical mechanism of arrhythmia in cases of fetal tachycardia. The potential to monitor fetal heart rate over a prolonged period is an advantage over current monitoring strategies for documentation of intermittent arrhythmias and gauging the response to medical therapy. These data will enable research to focus on improvement in signal quality, assessment of other arrhythmia subtypes, and real-time ambulatory monitoring of the fetal rhythm.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013556"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Two Different Cryoballoon Systems for Treatment of Paroxysmal Atrial Fibrillation: Results From the CONTRAST-CRYO Trial.","authors":"Shinsuke Miyazaki, Junichi Nitta, Kohki Nakamura, Atsushi Kobori, Osamu Inaba, Masato Murakami, Yasuteru Yamauchi, Yukio Sekiguchi, Takehito Sasaki, Yasuhiro Sasaki, Yukihiro Inamura, Shingo Mizuno, Yuichiro Sagawa, So Asano, Shigeto Naito, Junichi Ooka, Hiroaki Ohya, Takuro Nishimura, Akihiro Hirakawa, Tetsuo Sasano","doi":"10.1161/CIRCEP.125.014041","DOIUrl":"10.1161/CIRCEP.125.014041","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e014041"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scar Voltage Mapping in Fast Ventricular Tachycardia for Identifying Functional Substrates of Tachycardia Isthmuses: A Proof-of-Concept Study.","authors":"Alejandro Carta-Bergaz, Gonzalo R Ríos-Muñoz, Verónica Crisóstomo, Claudia Báez, Virginia Blanco, Francisco M Sánchez-Margallo, Javier Bermejo, Ángel Arenal-Maiz","doi":"10.1161/CIRCEP.125.013793","DOIUrl":"10.1161/CIRCEP.125.013793","url":null,"abstract":"<p><strong>Background: </strong>Identification of fast ventricular tachycardia (FVT; cycle length <320 ms) isthmuses is often hindered by hemodynamic instability during sustained FVT and by rate-dependent (functional) scar properties. Comparing ultra-high-density voltage heterogeneity maps (0.1-1.5 mV) of the scar area during sinus rhythm (SR) and FVT may delineate the rate-dependent components of the FVT isthmus (FVTI) and improve substrate identification during SR.</p><p><strong>Methods: </strong>Thirty Large White swine with anterior myocardial infarction underwent cardiac magnetic resonance imaging for signal intensity mapping, followed by electrophysiological studies at 4 and 16 weeks post-infarction. FVTIs were defined as corridors of high-frequency electrograms spanning electric diastole and completing reentrant circuits in activation maps. Voltage heterogeneity mapping during FVT and SR was performed to identify voltage channels and delineate functional substrate. Statistical comparisons were performed using the Student <i>t</i> test, with data presented as mean±SD.</p><p><strong>Results: </strong>Sixty ventricular tachycardias were induced, including 27 monomorphic episodes with a cycle length < 320 ms. Of these, 25 exhibited reentrant activation with identifiable FVTI. All FVTIs were housed within channels identified in voltage heterogeneity maps during FVT and signal intensity maps; 22 of 25 (88%) colocalized with a channel visible in SR voltage maps. Comparing FVT and SR voltage maps revealed that (1) dense scar area (<0.1 mV) was larger in FVT than in SR maps (1.5±0.3 versus 0.1±0.2 cm², <i>P</i><0.001), (2) voltage channels sustaining FVTI in FVT were longer than in SR (18.7±7.1 versus 14.6±6.1 mm, <i>P</i>=0.047), and (3) while all channels in FVT maps were bordered by dense scar (<0.1 mV), only 4 in SR exhibited this feature, indicating a functional substrate in 84% of FVTIs.</p><p><strong>Conclusions: </strong>FVTIs are located within channels identified in voltage heterogeneity maps during SR and FVT. These channels colocalize with heterogeneous tissue channels in signal intensity maps. Comparative analysis of SR and FVT voltage maps enables delineation of functional borders.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013793"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship Between Time-to-First Atrial Tachyarrhythmia Recurrence and Atrial Fibrillation Burden: Implications for Trial Design.","authors":"Jason G Andrade, Martin Aguilar, Richard G Bennett, Karim Benali, Marc W Deyell, Paul Khairy, Laurent Macle","doi":"10.1161/CIRCEP.125.013971","DOIUrl":"10.1161/CIRCEP.125.013971","url":null,"abstract":"<p><strong>Background: </strong>Atrial tachyarrhythmia recurrence remains the primary end point of clinical trials evaluating therapeutic pharmacological and nonpharmacological interventions for atrial fibrillation (AF). We sought to examine the relationship between the timing of first atrial tachyarrhythmia recurrence and subsequent AF burden.</p><p><strong>Methods: </strong>We performed a patient-level analysis of 2 multicenter prospective parallel-group, single-blinded randomized clinical trials that used continuous rhythm monitoring after rhythm intervention. Patients with paroxysmal AF were stratified based on the month where the first recurrence of atrial tachyarrhythmia was observed, after a 2-month blanking period. AF burden was calculated as the time spent in AF at 1 year after first recurrence and over 3 years of follow-up.</p><p><strong>Results: </strong>A total of 51.7% of patients experienced a recurrence of atrial tachyarrhythmia in the first year of follow-up. A first recurrence of atrial tachyarrhythmia occurred in 56.5% of patients within the third month post treatment initiation, with 79.5% of all recurrences detected by month 6 and 90.2% detected by month 9. The median postrecurrence AF burden was significantly greater in those with first recurrence in month 3 (1.04% [interquartile range, 0.23-5.05]) when compared with those patients with first recurrence between months 4 to 12 (0.13% [interquartile range, 0.04-0.63]; <i>P</i><0.0001 versus month 3) and those with first recurrence after month 12 (0.05% [interquartile range, 0.01-0.20]; <i>P</i><0.0001 versus month 3).</p><p><strong>Conclusions: </strong>Atrial tachyarrhythmia recurrence after rhythm control intervention for paroxysmal AF is not uniform, with earlier recurrences being associated with higher AF burden on follow-up. These findings suggest that the timing of arrhythmia recurrence is of critical importance, with later recurrences being of progressively lesser clinical significance.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013971"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep Learning Can Unmask Conduction Tissue Disease From an Ambulatory ECG.","authors":"Laurent Fiorina, Tanner Carbonati, Baptiste Maille, Kumar Narayanan, Pauline Porquet, Christine Henry, Jagmeet P Singh, Eloi Marijon, Jean-Claude Deharo","doi":"10.1161/CIRCEP.124.013695","DOIUrl":"10.1161/CIRCEP.124.013695","url":null,"abstract":"<p><strong>Background: </strong>Bradyarrhythmia is a common and potentially serious cause of syncope, often difficult to detect due to its intermittent nature. Traditional ECG monitoring methods either provide low diagnostic accuracy or delay diagnosis, increasing the risk of recurrence. We hypothesized that a deep learning-enabled, 24-hour, single-lead ECG could detect past episodes of bradyarrhythmia.</p><p><strong>Methods: </strong>Using unselected 14-day single-lead ambulatory ECG recordings, we developed a deep learning model to identify patients with prior asystole from sinus arrest or complete heart block. The model was trained using the last 24 hours of each recording, free of bradyarrhythmias, to identify daytime sinus pause of ≥3 s, anytime sinus pause of ≥6 s, complete heart block, or a composite of these bradyarrhythmias from the previous 13 days.</p><p><strong>Results: </strong>A total of 320 959 unselected 14-day ambulatory ECG recordings (mean age, 60.5±17.8 years; 60% female) were split into training (n=189 414), tuning (n=45 982), internal validation (n=43 390), and external validation (n=42 173) sets. External validation of prior daytime sinus pause ≥3 s, anytime sinus pause ≥6 s, complete heart block, and a composite end point demonstrated an area under the receiver operating characteristic curve of 0.89, 0.87, 0.93, and 0.89, respectively, with negative predictive values between 97.9 and 99.9%. In addition to this approach of uncovering past events, our model was also tested for its ability to predict bradyarrhythmias within the following 13 days using the first 24 hours of ECG data, achieving an AUC of 0.88 for the composite end point.</p><p><strong>Conclusions: </strong>A deep learning-enabled ambulatory ECG is capable of unmasking underlying conduction tissue system disease. This tool may help identify patients with significant intermittent bradyarrhythmia, potentially improving timely diagnosis and management.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013695"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes of Right Ventricular Apical, Septal, and Conduction System Pacing in the Medicare Population.","authors":"Pugazhendhi Vijayaraman, Colleen Longacre, Jordana Kron, George H Crossley","doi":"10.1161/CIRCEP.125.013940","DOIUrl":"10.1161/CIRCEP.125.013940","url":null,"abstract":"","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013940"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442776/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"RYR2 Variants in Catecholaminergic Polymorphic Ventricular Tachycardia Patients: Insights From Protein Structure and Clinical Data.","authors":"Alexander Chang, Halil Beqaj, Leah Sittenfeld, Marco C Miotto, Haikel Dridi, Gloria Willson, Carolyn Martinez Jorge, Jaan Altosaar Li, Steven Reiken, Yang Liu, Zonglin Dai, Carl Tchagou, Sana Elsayed, Steven O Marx, Andrew R Marks","doi":"10.1161/CIRCEP.124.013757","DOIUrl":"10.1161/CIRCEP.124.013757","url":null,"abstract":"<p><strong>Background: </strong>Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited arrhythmia, with pathogenic variants in the <i>RYR2</i> gene responsible for 60% of clinically well-defined CPVT cases. Diagnosis of CPVT often occurs after a major cardiac event, posing a severe threat to the patient's life. A data set of patients with CPVT would improve the diagnosis and treatment of patients with CPVT.</p><p><strong>Methods: </strong>This review cataloged clinical data on patients with <i>RYR2</i>-related CPVT variants from articles published up to October 2020 from PubMed, Scopus, and Embase. Variants were mapped to the structural domains of RYR2. Differences in the age of onset based on variant location and incidence of CPVT symptoms, and differences in treatment strategies were analyzed.</p><p><strong>Results: </strong>In 221 publications analyzed, 964 patients with CPVT (351 male, 463 female) were identified with 263 <i>RYR2</i> protein-coding variants and a median age of onset of CPVT of 11 years (interquartile range, 7-14 years). A web app was developed to allow users to query the database and is available at https://markslab-cpvtdb.org. The proportion of patients requiring treatments in addition to β-blockers varied between variants. The age of onset of CPVT differed significantly between <i>RYR2</i> variants located in different exons, domains, and subdomains. Patients with variants in the core solenoid at the domain level, and the core solenoid (exEF-hand) and channel pore at the subdomain level, tended to have a lower age of onset compared with other regions.</p><p><strong>Conclusions: </strong>This study compiled a comprehensive data set of CPVT-associated <i>RYR2</i> variants and their clinical phenotypes. The age of onset in certain domains (core solenoid) and subdomains (core solenoid[exEF-hand], channel pore) tended to be lower compared with other regions. Variability in patient phenotypes, such as age of onset and treatment efficacy, along with structural information on variants, suggests that patients may benefit from personalized interventions based on their variant.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013757"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12442783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of Structural Versus Cellular Remodeling in Atrial Arrhythmogenesis: Insights From Personalized Digital Twins.","authors":"Andrey V Pikunov, Roman A Syunyaev, Rheeda Ali, Adityo Prakosa, Anna Gams, Patrick M Boyle, Vanessa Steckmeister, Ingo Kutschka, Eric Rytkin, Niels Voigt, Natalia Trayanova, Igor R Efimov","doi":"10.1161/CIRCEP.125.013898","DOIUrl":"10.1161/CIRCEP.125.013898","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is a progressive disease involving both structural and functional remodeling. Although over the past decade, digital twin-guided therapy has been proposed and applied, accounting for cardiomyocyte functional remodeling remains challenging. We aimed to investigate the contribution of functional remodeling at the cellular level to AF pathogenesis in patients with fibrotic remodeling and to develop novel techniques to predict the location of reentrant drivers.</p><p><strong>Methods: </strong>To investigate the contribution of cell-scale functional remodeling to AF pathogenesis under the conditions of fibrotic remodeling, we combined 3-dimensional atrial digital twins with pathology-specific single-cell models. The latter were developed using recordings in myocytes isolated from patients in sinus rhythm, paroxysmal, postoperative, and persistent AF. To quantify AF dynamics in the digital twins, we developed a novel algorithm for locating reentrant drivers by backtracking the conduction velocity field from the wavebreak regions.</p><p><strong>Results: </strong>We demonstrate that our novel algorithm is at least 700× faster than the traditional phase singularity analysis. The inducibility of simulated AF was not pathology-dependent, but pathological models demonstrate a more extensive arrhythmogenic substrate than the sinus rhythm. We observed a correlation between wavebreak probability and fibrosis density, with the highest regression slope for the persistent AF model and the lowest for the sinus rhythm model.</p><p><strong>Conclusions: </strong>AF driver locations in atrial fibrotic substrates depend on electrophysiological remodeling; differences between pathology-specific models are explained by differences in wavebreak patterns. Specifically, reentrant drivers tend to dwell in the regions with the highest wavebreak probability.</p>","PeriodicalId":10319,"journal":{"name":"Circulation. Arrhythmia and electrophysiology","volume":" ","pages":"e013898"},"PeriodicalIF":9.8,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144944908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}