N Engl J Med
Digital twin heart shows promising results in arrhythmia ablation
Clinical takeaway: Digital twin–guided ablation may improve targeting and outcomes in ventricular tachycardia, but evidence is limited to a small, single-center study.
Catheter ablation for ventricular tachycardia can be prolonged and imprecise, with recurrence rates of about 40% using standard approaches. Digital twin models—patient-specific simulations based on cardiac MRI—aim to identify optimal ablation targets before the procedure.
In this FDA-approved investigational device study (N=10), digital twin–guided ablation rendered ventricular tachycardia noninducible in all patients at the end of the procedure. Over a mean follow-up of ~13 months, 8 of 10 patients remained free of recurrent arrhythmia without antiarrhythmic drugs; 2 had early recurrences that resolved with therapy adjustment. No periprocedural complications were reported.
These findings support feasibility and potential clinical benefit though larger trials are needed to confirm efficacy and durability, according to a letter from investigators.
“In the patient’s digital twin, we can try different scenarios for treatment before we treat the actual patient and provide the treating physician with the best, most optimal scenario, minimizing damage to the heart, and increasing the potential for a successful treatment,” said senior author Natalia Trayanova, professor of Biomedical Engineering at Johns Hopkins University, whose team developed the technology. “The digital twin allows us to address all potential sources of arrythmias that may not be seen by clinical interrogation.”
Source: Chrispin J, et al. N Engl J Med. April 1, 2026. Digital Twin–Guided Ablation for Ventricular Tachycardia.