It would be clinically valuable if the efficacy of antiarrhythmic drugs could be simulated in advance. We developed a digital twin to predict amiodarone efficacy in high-risk atrial fibrillation (AF) patients post-ablation. Virtual left atrium models were created from computed tomography and electroanatomical maps to simulate AF and evaluate its response to varying amiodarone concentrations. As the amiodarone concentration increased in the virtual setting, action potential duration lengthened, peak upstroke velocities decreased, and virtual AF termination became more frequent. Patients were classified into effective (those with virtually terminated AF at therapeutic doses) and ineffective groups. The one-year clinical outcomes after AF ablation showed significantly better results in the effective group compared to the ineffective group, with AF recurrence rates of 20.8% vs. 45.1% (log-rank p = 0.031, adjusted hazard ratio, 0.37 [0.14-0.98]; p = 0.046). This study highlights the potential of a digital twin-guided approach in predicting amiodarone’s effectiveness and improving personalized AF management. Clinical Trial Registration Name: The Evaluation for Prognostic Factors After Catheter Ablation of Atrial Fibrillation: Cohort Study, Registration number: NCT02138695. The date of registration: 2014-05. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02138695.

如果可以提前模拟抗心律失常药物的疗效，将具有临床价值。我们开发了一个数字孪生来预测胺碘酮对消融后高危心房颤动 （AF） 患者的疗效。根据计算机断层扫描和电解剖图创建虚拟左心房模型，以模拟 AF 并评估其对不同胺碘酮浓度的反应。随着虚拟环境中胺碘酮浓度的增加，动作电位持续时间延长，峰值上风速度降低，虚拟 AF 终止变得更加频繁。患者分为有效组 （在治疗剂量下 AF 几乎终止的患者） 和无效组。与无效组相比，AF 消融后 1 年临床结局显示有效组的结果明显更好，AF 复发率为 20.8% vs. 45.1% （对数秩 p = 0.031，调整后风险比，0.37 [0.14-0.98];p = 0.046）。本研究强调了数字孪生引导方法在预测胺碘酮的有效性和改善个性化 AF 管理方面的潜力。临床试验注册名称： 心房颤动导管消融术后预后因素评估：队列研究，注册号：NCT02138695。注册日期：2014-05。网址：https://www.clinicaltrials.gov;唯一标识符：NCT02138695。