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Review
. 2024 Dec 26;27(1):euae304.
doi: 10.1093/europace/euae304.

Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation

Eva Schuijt  1 , Daniel Scherr  2 , Gernot Plank  3 , Ulrich Schotten  1 , Jordi Heijman  3   4
Affiliations
Review

Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation

Eva Schuijt et al. Europace. .

Abstract

In 1924, the Dutch physiologist Willem Einthoven received the Nobel Prize in Physiology or Medicine for his discovery of the mechanism of the electrocardiogram (ECG). Anno 2024, the ECG is commonly used as a diagnostic tool in cardiology. In the paper 'Le Télécardiogramme', Einthoven described the first recording of the now most common cardiac arrhythmia: atrial fibrillation (AF). The treatment of AF includes rhythm control, aiming to alleviate symptoms and improve quality of life. Recent studies found that early rhythm control might additionally improve clinical outcomes. However, current therapeutic options have suboptimal efficacy and safety, highlighting a need for better rhythm-control strategies. In this review, we address the challenges related to antiarrhythmic drugs (AADs) and catheter ablation for rhythm control of AF, including significant recurrence rates and adverse side effects such as pro-arrhythmia. Furthermore, we discuss potential solutions to these challenges including novel tools, such as atrial-specific AADs and digital-twin-guided AF ablation. In particular, digital twins are a promising method to integrate a wide range of clinical data to address the heterogeneity in AF mechanisms. This may enable a more mechanism-based tailored approach that may overcome the limitations of previous precision medicine approaches based on individual biomarkers. However, several translational challenges need to be addressed before digital twins can be routinely applied in clinical practice, which we discuss at the end of this narrative review. Ultimately, the significant advances in the detection, understanding, and treatment of AF since its first ECG documentation are expected to help reduce the burden of this troublesome condition.

Keywords: Ablation; Antiarrhythmic drugs; Atrial fibrillation; Digital twins; Precision medicine; Rhythm control.

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Conflict of interest statement

Conflict of interest: U.S. received consultancy fees or honoraria from Università della Svizzera Italiana (USI, Switzerland), Roche Diagnostics (Switzerland), EP Solutions Inc. (Switzerland), Johnson & Johnson Medical Limited (UK), Bayer Healthcare (Germany). U.S. is co-founder and shareholder of YourRhythmics BV, a spin-off company of the University Maastricht. G.P. is a co-founder of NumeriCor GmbH. All the remaining authors have declared no conflicts of interest.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Timeline of key developments in atrial fibrillation detection methods. Photographs reproduced from Salam under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License.
Figure 2
Figure 2
Overview of tailored-ablation strategies. CFAEs, complex fractionated atrial electrograms; ECG, electrocardiogram.
Figure 3
Figure 3
Schematic representation of the use of a digital twin for determining atrial fibrillation ablation strategies.
See this image and copyright information in PMC

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