Fig. 3: Examples of differential efficacy of each strategy.

a A patient for whom there was an added benefit of PWI over WA-PVI in decreasing LA arrhythmogenesis in the DT. The patient’s DT incorporating fibrosis (light-green), with LA-LR distribution (light-blue dots), virtual ablation (red lines) representing PWI + PVI (top) and WA-PVI (bottom) lesions, probing post-ablation inducibility and identifying the eliminated and remaining LRs (white circular arrows indicating reentry), and investigation of the features of the fibrosis (top) and the electro-anatomical map (bottom) at LAPW. b A patient for whom added PWI was not beneficial over WA-PVI, but WA-PVI provided added benefit over IO-PVI in eliminating LA-LRs. The patient’s DT incorporating fibrosis (light-green), with LA-LR distribution (light-blue dots), virtual ablation (red lines) representing PWI + PVI (top-left), WA-PVI (top-right), and IO-PVI (bottom) lesions, probing post-ablation inducibility and identifying the eliminated and remaining LRs (white circular arrows indicating reentry), and investigation of the features of the fibrosis at PV antrums. DT digital twin, FE fibrosis entropy, FF fibrosis fraction, IO-PVI individual ostial PVI, LA left atrium, LAPW LA posterior wall, LR location of reentry, LVA low-voltage area, PVI pulmonary vein isolation, PWI + PVI LAPW isolation plus WA-PVI, WA-PVI wide antral PVI.