Fig. 1: AF digital twins, AF induction protocol, and virtual interventions.

a We integrated the patient’s CT image and electroanatomical map to create a digital twin of LA. Virtual maps of patients, including voltage, local activation time, fiber orientation, and fibrosis maps, represent LA’s histological and electrophysiological properties. b We induced virtual AF with ramp pacing protocol. The action potential of the triangle site shows successful induction and maintenance of virtual AF. c We draw the virtual antral line, ostial line with single width (2 mm), and ostial line width triple width (6 mm) for every 50 patients. The green line indicates the ablation line. d Orange arrows indicate the gaps of PVI. The standard position of the gap is on both PVs’ upper, lower, anterior, and posterior parts. e We changed pacing sites from Bachman’s bundle area to the inside PV. AF atrial fibrillation, AP action potential, CT computed tomography, LA left atrium, PV pulmonary vein, PVI pulmonary vein isolation.