Evidence map›Paper›PMID 41894228›Full record

ArticleEuropace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology2026

Relationships between three-dimensional fibrosis distribution, atrial adiposity, and voltage abnormalities associated with persistent atrial fibrillation.

Kensuke Sakata, Adityo Prakosa, Carolyna A P Yamamoto, Syed Yusuf Ali, Yazan Mohsen, Shane Loeffler, Eugene G Kholmovski, Joseph E Marine, Hugh Calkins, David D Spragg and 1 more

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Article in Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Kensuke SakataAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0000-0003-0204-3613
Adityo PrakosaAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0000-0002-1590-0322
Carolyna A P YamamotoDepartment of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St., Wyman Park Building, Suite 400 West, Baltimore, MD 21218, USA.ORCID 0000-0001-6735-045X
Syed Yusuf AliDepartment of Biomedical Engineering, Johns Hopkins University, 3400 N. Charles St., Wyman Park Building, Suite 400 West, Baltimore, MD 21218, USA.ORCID 0000-0002-2706-2717
Yazan MohsenAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0009-0002-3932-2106
Shane LoefflerAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0000-0002-5080-2330
Eugene G KholmovskiAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0000-0002-3271-7247
Joseph E MarineDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.ORCID 0000-0001-5035-5342
Hugh CalkinsDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.ORCID 0000-0002-9262-9433
David D SpraggDivision of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.ORCID 0000-0002-9190-9804
Natalia A TrayanovaAlliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, 3400 N. Charles St.Hackerman Hall 213, Baltimore, MD 21218, USA.ORCID 0000-0002-8661-063X

Funding

Artificial intelligence analysis of atrial remodeling evolution in patients with atrial fibrillation: Towards optimal ablation strategiesR01HL166759 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI Eugene Kholmovski, David Spragg · 2023 to 2026
$3.2M
Heart Digital Twin Analysis of Arrhythmias due to Infiltrating AdiposityR01HL174440 · NHLBI · JOHNS HOPKINS UNIVERSITY · PI NATALIA A. TRAYANOVA · 2024 to 2026
$2.1M
Leducq Foundation 23CVD04NIH HHS R01HL166759NIH HHS R01HL174440
6 · The paper itself

Abstract

aimsPersistent atrial fibrillation (PsAF) is often refractory to pulmonary vein isolation, a well-established AF treatment, owing to the fibrosis-remodelled substrates sustaining re-entries. Three-dimensional fibrosis distribution and atrial adiposity have been found to be essential contributors to PsAF arrhythmogenesis. We aimed to utilize late gadolinium enhancement (LGE)-MRI-derived personalized heart digital twins (DTs)-a recent promising tool for non-invasively assessing patient arrhythmogenesis-as well as contrast-enhanced cardiac computed tomography (CCT) images and electroanatomic maps (EAMs) to investigate relationships between fibrosis distribution, including endo-epi differences, adiposity infiltration, and electrophysiological abnormalities, and their influence on PsAF arrhythmogenic substrate. METHODS AND

resultsDigital twins incorporating fibrosis distribution were generated from consecutive PsAF patients' LGE-MRIs. Using rapid pacing, potential locations attracting re-entries (LRs) were identified in DTs. Cardiac computed tomographies were used to segment adipose tissue within pericardial sac and evaluate the distance from endocardial surface to closest adipose tissue (DEnCA). Bipolar and unipolar-low-voltage area fractions (LVFs) were extracted from EAMs. Volumetric-fibrosis fraction (FF) and surface-FF on endocardial and epicardial surfaces at LRs and non-LRs were analysed in relation to DEnCA and LVF. In 22 patients, adipose tissue volume correlated with BMI and CHA2DS2-VASc and, together with atrial-FF, predicted number of LRs. At LRs and non-LRs, while volumetric-FF was the sole determinant of LR classification, volumetric-FF correlated with endocardium-predominant fibrosis and bipolar LVF. Endocardium-predominant fibrosis was independently linked to DEnCA.

conclusionThis study highlights the complex interactions between structural features, such as three-dimensional fibrosis distribution and atrial adiposity infiltration, electrophysiological features, and PsAF arrhythmogenesis.

Indexed as

AdiposityAtrial FibrillationAtrial RemodelingHeart AtriaAction PotentialsAgedContrast MediaElectrophysiologic Techniques, CardiacEpicardial Adipose TissueFemaleFibrosisHumansImaging, Three-DimensionalMagnetic Resonance ImagingMaleMiddle AgedContrast MediaArrhythmogenic substrateAtrial adiposityDigital twinFibrosisLow-voltage areaPersistent atrial fibrillation

Identifiers

PMID41894228
PMCPMC13122363

What Socratic holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.