Aims Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, but recurrences are frequent. Ablating AF sources beyond PVI may prevent re-initiations. This proof-of-principle in silico study compares a novel source-based ablation approach to conventional strategies in preventing AF re-initiation. Methods and results We compared two conventional ablation strategies [PVI and PVI + posterior wall isolation (box ablation)] with our source-based approach. After PVI, a high-density mapping catheter was guided sequentially upstream of local repetitive conduction patterns until a source was identified. Located targets were ablated, connecting them to non-conducting boundaries. Strategies were compared based on their AF re-initiation rates after incremental pacing and ablated and electrically isolated areas. Analyses were performed in seven different scenarios with atria of different sizes, without (n = 3) and with fibrosis (n = 4), to assess different AF progression stages. Compared to no ablation, PVI reduced initiation rates in non-fibrotic atria (23 ± 8\% control vs. 15 ± 0\% PVI) but was less effective with fibrosis (60 ± 4\% vs. 53 ± 10\%). Box ablation was not superior to PVI while isolating more of the left atrium (isolated area in PVI: 31.5 ± 0.7\% vs. box: 43.6 ± 0.5\%). Conversely, source ablation completely prevented AF initiation in all scenarios, achieving comparable left atrial isolation with box ablation (isolated area without fibrosis: 36.3 ± 1.4\%; with fibrosis: 43.2 ± 2.6\%) and including right atrial lesions. Although macro-re-entrant tachycardias occurred frequently after source ablation, they were terminated with minimal lesions. Conclusion Ablating AF sources using our high-density mapping approach was more efficient in preventing AF re-initiation in silico than anatomy-based strategies.
Gonçalves Marques, V, Gharaviri, A, Özgül, O, Pezzuto, S, Auricchio, A, Vernooy, K, Linz, D, Hermans, B, Bonizzi, P, Zeemering, S & Schotten, U 2026, 'Ablation of atrial fibrillation sources identified through sequential high-density mapping: in silico comparison against anatomy-based approaches', Europace, vol. 28, no. 1, euaf304. https://doi.org/10.1093/europace/euaf304
Gonçalves Marques, V., Gharaviri, A., Özgül, O., Pezzuto, S., Auricchio, A., Vernooy, K., Linz, D., Hermans, B., Bonizzi, P., Zeemering, S., & Schotten, U. (2026). Ablation of atrial fibrillation sources identified through sequential high-density mapping: in silico comparison against anatomy-based approaches. Europace, 28(1), Article euaf304. https://doi.org/10.1093/europace/euaf304
@article{2b00f4c618b94473bc5cb995b6d9232e,
title = "Ablation of atrial fibrillation sources identified through sequential high-density mapping: in silico comparison against anatomy-based approaches",
abstract = "Aims Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation, but recurrences are frequent. Ablating AF sources beyond PVI may prevent re-initiations. This proof-of-principle in silico study compares a novel source-based ablation approach to conventional strategies in preventing AF re-initiation. Methods and results We compared two conventional ablation strategies [PVI and PVI + posterior wall isolation (box ablation)] with our source-based approach. After PVI, a high-density mapping catheter was guided sequentially upstream of local repetitive conduction patterns until a source was identified. Located targets were ablated, connecting them to non-conducting boundaries. Strategies were compared based on their AF re-initiation rates after incremental pacing and ablated and electrically isolated areas. Analyses were performed in seven different scenarios with atria of different sizes, without (n = 3) and with fibrosis (n = 4), to assess different AF progression stages. Compared to no ablation, PVI reduced initiation rates in non-fibrotic atria (23 ± 8\% control vs. 15 ± 0\% PVI) but was less effective with fibrosis (60 ± 4\% vs. 53 ± 10\%). Box ablation was not superior to PVI while isolating more of the left atrium (isolated area in PVI: 31.5 ± 0.7\% vs. box: 43.6 ± 0.5\%). Conversely, source ablation completely prevented AF initiation in all scenarios, achieving comparable left atrial isolation with box ablation (isolated area without fibrosis: 36.3 ± 1.4\%; with fibrosis: 43.2 ± 2.6\%) and including right atrial lesions. Although macro-re-entrant tachycardias occurred frequently after source ablation, they were terminated with minimal lesions. Conclusion Ablating AF sources using our high-density mapping approach was more efficient in preventing AF re-initiation in silico than anatomy-based strategies.",
keywords = "Ablation, Atrial fibrillation, Atrial fibrillation sources, Computer models, Fibrosis, Repetitiveness, Sequential mapping, Advisor HD-Grid Mapping Catheter Sensor Enabled, mapping catheter, anatomical concepts, article, atrial fibrillation, catheter ablation, computer model, controlled study, fibrosis, heart left atrium, heart right atrium, heart size, pulmonary vein isolation, supraventricular tachycardia",
author = "\{Gon{\c c}alves Marques\}, Victor and Ali Gharaviri and Ozan {\"O}zg{\"u}l and Simone Pezzuto and Angelo Auricchio and Kevin Vernooy and Dominik Linz and Ben Hermans and Pietro Bonizzi and Stef Zeemering and Ulrich Schotten",
note = "Publisher Copyright: {\textcopyright} The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.",
year = "2026",
month = jan,
day = "1",
doi = "10.1093/europace/euaf304",
language = "English",
volume = "28",
journal = "Europace",
issn = "1099-5129",
publisher = "Oxford University Press",
number = "1",
}