{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:26:52Z","timestamp":1790364412596,"version":"4.1.0"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2024,6,13]],"date-time":"2024-06-13T00:00:00Z","timestamp":1718236800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020"},{"name":"Marie Sk\u0142odowska-Curie","award":["860974"],"award-info":[{"award-number":["860974"]}]},{"name":"EPSRC Impact Acceleration Account Award","award":["EP\/X525777\/1"],"award-info":[{"award-number":["EP\/X525777\/1"]}]},{"name":"Wellcome Trust Senior Fellowship in Basic Biomedical Sciences","award":["214 290\/Z\/18\/Z"],"award-info":[{"award-number":["214 290\/Z\/18\/Z"]}]},{"name":"CompBioMed and CompBiomed2 Centre of Excellence in Computational Biomedicine"},{"name":"European Union\u2019s Horizon 2020","award":["675 451"],"award-info":[{"award-number":["675 451"]}]},{"name":"European Union\u2019s Horizon 2020","award":["823 712"],"award-info":[{"award-number":["823 712"]}]},{"name":"Oxford Biomedical Research Centre and the CompBiomedX EPSRC-funded project","award":["EP\/X019446\/1"],"award-info":[{"award-number":["EP\/X019446\/1"]}]},{"DOI":"10.13039\/501100005617","name":"Oxford BHF Centre of Research Excellence","doi-asserted-by":"crossref","award":["RE\/13\/1\/30 181"],"award-info":[{"award-number":["RE\/13\/1\/30 181"]}],"id":[{"id":"10.13039\/501100005617","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001943","name":"PRACE","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001943","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Piz Daint at the Swiss National Supercomputing Centre","award":["icp019"],"award-info":[{"award-number":["icp019"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,6,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Patients with persistent atrial fibrillation (AF) experience 50% recurrence despite pulmonary vein isolation (PVI), and no consensus is established for secondary treatments. The aim of our i-STRATIFICATION study is to provide evidence for stratifying patients with AF recurrence after PVI to optimal pharmacological and ablation therapies, through in silico trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>A cohort of 800 virtual patients, with variability in atrial anatomy, electrophysiology, and tissue structure (low-voltage areas, LVAs), was developed and validated against clinical data from ionic currents to electrocardiogram. Virtual patients presenting AF post-PVI underwent 12 secondary treatments. Sustained AF developed in 522 virtual patients after PVI. Second ablation procedures involving left atrial ablation alone showed 55% efficacy, only succeeding in the small right atria (&amp;lt;60\u2005mL). When additional cavo-tricuspid isthmus ablation was considered, Marshall-PLAN sufficed (66% efficacy) for the small left atria (&amp;lt;90\u2005mL). For the bigger left atria, a more aggressive ablation approach was required, such as anterior mitral line (75% efficacy) or posterior wall isolation plus mitral isthmus ablation (77% efficacy). Virtual patients with LVAs greatly benefited from LVA ablation in the left and right atria (100% efficacy). Conversely, in the absence of LVAs, synergistic ablation and pharmacotherapy could terminate AF. In the absence of ablation, the patient\u2019s ionic current substrate modulated the response to antiarrhythmic drugs, being the inward currents critical for optimal stratification to amiodarone or vernakalant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In silico trials identify optimal strategies for AF treatment based on virtual patient characteristics, evidencing the power of human modelling and simulation as a clinical assisting tool.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euae150","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T18:02:43Z","timestamp":1718042563000},"source":"Crossref","is-referenced-by-count":37,"title":["<i>In Silico<\/i>\n                    TRials guide optimal stratification of ATrIal FIbrillation patients to Catheter Ablation and pharmacological medicaTION: the i-STRATIFICATION study"],"prefix":"10.1093","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8649-8203","authenticated-orcid":false,"given":"Albert","family":"Das\u00ed","sequence":"first","affiliation":[{"name":"Department of Computer Science, University of Oxford , Wolfson Building, Parks Road, Oxford OX1 3QD , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4193-7257","authenticated-orcid":false,"given":"Claudia","family":"Nagel","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4166-3746","authenticated-orcid":false,"given":"Michael T B","family":"Pope","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oxford University Hospitals NHS Foundation Trust , Oxford , UK"},{"name":"Department for Human Development and Health, University of Southampton , Southampton , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-8343","authenticated-orcid":false,"given":"Rohan S","family":"Wijesurendra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oxford University Hospitals NHS Foundation Trust , Oxford , UK"},{"name":"Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9063-9905","authenticated-orcid":false,"given":"Timothy R","family":"Betts","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oxford University Hospitals NHS Foundation Trust , Oxford , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0800-5984","authenticated-orcid":false,"given":"Rafael","family":"Sachetto","sequence":"additional","affiliation":[{"name":"Departamento de Ci\u00eancia da Computa\u00e7\u00e3o, Universidade Federal de S\u00e3o Jo\u00e3o del Rei , S\u00e3o Jo\u00e3o del Rei, MG , Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2487-4744","authenticated-orcid":false,"given":"Axel","family":"Loewe","sequence":"additional","affiliation":[{"name":"Institute of Biomedical Engineering, Karlsruhe Institute of Technology (KIT) , Karlsruhe , Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1634-3601","authenticated-orcid":false,"given":"Alfonso","family":"Bueno-Orovio","sequence":"additional","affiliation":[{"name":"Department of Computer Science, University of Oxford , Wolfson Building, Parks Road, Oxford 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