Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations

doi:10.1016/j.hrthm.2026.09.057

Arrhythmias & electrophysiologyResearch article

Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations

Heart RhythmPublished 9 Oct 2026

Image-personalized computational simulations

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Authors' conclusion

Adding EAT effects to fibrosis-based models increased sustained functional reentry, with transmural depth contributing only modestly. Reentry anchored preferentially where fibrosis and EAT effects coexisted.

Study context

Population: Patients with persistent atrial fibrillation (AF), left atrial (LA) fibrosis and epicardial adipose tissue (EAT) quantified by LGE and Dixon MRIpatients, 855 simulations
Participants: 19 patients

Comparison: Fibrosis-based models with vs without EAT-associated effects

Main finding

As reported in the abstract

Sustained reentry

Simulations with sustained reentry

370 simulations (43.3%)

of which with a functional (rotor-driven) component

306

Further findings

Functional reentry inducibility

fibrosis only22.8%

half-EAT41.4%

full-EAT43.2%

Models with at least one functional reentry fibrosis only 12/19 · half-EAT 18/19 · full-EAT 19/19

Median

Outcome	fibrosis only	half-EAT	full-EAT	P value
Median inducible simulations per patient — half-EAT vs fibrosis only	4	6	7	P = 0.004
Median inducible simulations per patient — full-EAT vs fibrosis only				P = 0.003
Median inducible simulations per patient — half-EAT vs full-EAT · no significant difference				P = 0.895
Volume harboring reentry by tissue region	37.3%	Not reported in the abstract	Not reported in the abstract

Volume harboring reentry by tissue region: Fibrosis/EAT overlap median 65.5% · Share of LA wall 2.1%
Volume harboring reentry by tissue region: non-substrate median 8.8%
Volume harboring reentry by tissue region: EAT median 42.8%
Volume harboring reentry by tissue region: all p<0.001

1-year recurrence in PVI-only ablation patients (exploratory)

Fibrosis-EAT overlap outside the PVI region associated with 1-year recurrence: log-rank p=0.007

exploratory analysis
n=13

Original publication

Substrate Comprising Fibrosis and Epicardial Adipose Tissue-Associated Electrophysiological Remodeling Can Sustain Atrial Fibrillation Drivers: Insights from Image-Personalized Computational Simulations. Heart Rhythm. Published 9 October 2026. doi:10.1016/j.hrthm.2026.09.057

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Summarised from the published abstract; every number is checked against it