{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T13:34:14Z","timestamp":1782480854907,"version":"3.54.5"},"reference-count":163,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T00:00:00Z","timestamp":1735257600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Netherlands Heart Foundation","award":["01-002-2022-0118"],"award-info":[{"award-number":["01-002-2022-0118"]}]},{"name":"Electro-Molecular Basis and the Rapeutic management of Atrial Cardiomyopathy"},{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Machine Learning Artificial Intelligence Early Detection Stroke Atrial Fibrillation","award":["965286"],"award-info":[{"award-number":["965286"]}]},{"name":"Ground-BrEAking Electroporation-based inTervention for Atrial Fibrillation treatment","award":["945125"],"award-info":[{"award-number":["945125"]}]},{"DOI":"10.13039\/501100003246","name":"Netherlands Organisation for Scientific Research","doi-asserted-by":"publisher","award":["09150171910029"],"award-info":[{"award-number":["09150171910029"]}],"id":[{"id":"10.13039\/501100003246","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,12,26]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In 1924, the Dutch physiologist Willem Einthoven received the Nobel Prize in Physiology or Medicine for his discovery of the mechanism of the electrocardiogram (ECG). Anno 2024, the ECG is commonly used as a diagnostic tool in cardiology. In the paper \u2018Le T\u00e9l\u00e9cardiogramme\u2019, Einthoven described the first recording of the now most common cardiac arrhythmia: atrial fibrillation (AF). The treatment of AF includes rhythm control, aiming to alleviate symptoms and improve quality of life. Recent studies found that early rhythm control might additionally improve clinical outcomes. However, current therapeutic options have suboptimal efficacy and safety, highlighting a need for better rhythm-control strategies. In this review, we address the challenges related to antiarrhythmic drugs (AADs) and catheter ablation for rhythm control of AF, including significant recurrence rates and adverse side effects such as pro-arrhythmia. Furthermore, we discuss potential solutions to these challenges including novel tools, such as atrial-specific AADs and digital-twin-guided AF ablation. In particular, digital twins are a promising method to integrate a wide range of clinical data to address the heterogeneity in AF mechanisms. This may enable a more mechanism-based tailored approach that may overcome the limitations of previous precision medicine approaches based on individual biomarkers. However, several translational challenges need to be addressed before digital twins can be routinely applied in clinical practice, which we discuss at the end of this narrative review. Ultimately, the significant advances in the detection, understanding, and treatment of AF since its first ECG documentation are expected to help reduce the burden of this troublesome condition.<\/jats:p>","DOI":"10.1093\/europace\/euae304","type":"journal-article","created":{"date-parts":[[2024,12,27]],"date-time":"2024-12-27T15:08:22Z","timestamp":1735312102000},"source":"Crossref","is-referenced-by-count":21,"title":["Evolution in electrophysiology 100 years after Einthoven: translational and computational innovations in rhythm control of atrial fibrillation"],"prefix":"10.1093","volume":"27","author":[{"given":"Eva","family":"Schuijt","sequence":"first","affiliation":[{"name":"Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5868-5493","authenticated-orcid":false,"given":"Daniel","family":"Scherr","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Medical University of Graz , Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7380-6908","authenticated-orcid":false,"given":"Gernot","family":"Plank","sequence":"additional","affiliation":[{"name":"Division of Medical Physics and Biophysics, Gottfried Schatz Research Center, Medical University of Graz , Neue Stiftingtalstr. 6, 8010 Graz ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-3315","authenticated-orcid":false,"given":"Ulrich","family":"Schotten","sequence":"additional","affiliation":[{"name":"Department of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University , Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1418-108X","authenticated-orcid":false,"given":"Jordi","family":"Heijman","sequence":"additional","affiliation":[{"name":"Division of Medical Physics and Biophysics, Gottfried Schatz Research Center, Medical University of Graz , Neue Stiftingtalstr. 6, 8010 Graz ,","place":["Austria"]},{"name":"Department of Cardiology, CARIM School for Cardiovascular Diseases, Maastricht University and Maastricht University Medical Center , Universiteitssingel 50, 6229 ER Maastricht ,","place":["The Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,12,27]]},"reference":[{"key":"2025013112544776900_euae304-B1","first-page":"174","article-title":"Einthoven\u2019s string galvanometer: the first electrocardiograph","volume":"35","author":"Rivera-Ruiz","year":"2008","journal-title":"Tex Heart Inst J"},{"key":"2025013112544776900_euae304-B2","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2025013112544776900_euae304-B3","first-page":"132","article-title":"Le T\u00e9l\u00e9cardiogramme","volume":"4","author":"Einthoven","year":"1906","journal-title":"Arch Int Physiol"},{"key":"2025013112544776900_euae304-B4","doi-asserted-by":"crossref","first-page":"2982","DOI":"10.1016\/j.jacc.2020.11.010","article-title":"Global burden of cardiovascular diseases and risk factors, 1990\u20132019: update from the GBD 2019 study","volume":"76","author":"Roth","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"2025013112544776900_euae304-B5","doi-asserted-by":"crossref","first-page":"k1453","DOI":"10.1136\/bmj.k1453","article-title":"Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham heart study","volume":"361","author":"Staerk","year":"2018","journal-title":"BMJ"},{"key":"2025013112544776900_euae304-B6","doi-asserted-by":"crossref","first-page":"3314","DOI":"10.1093\/eurheartj\/ehae176","article-title":"2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): developed by the Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC), with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. 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