Patient-Specific Cardiac Digital Twin Guides Ventricular Tachycardia Ablation

Catheter ablation for ventricular tachycardia after myocardial infarction is lengthy, technically demanding, and prone to recurrence. Repeat procedures add scar burden and keep many patients on antiarrhythmic drugs. Researchers now report that patient-specific cardiac digital twins can guide ablation planning and execution. In a first clinical trial, this strategy was associated with durable suppression of malignant ventricular arrhythmias.

Cardiac digital twin technology developed at Johns Hopkins University creates personalized computational replicas of each patient’s heart. The models are built from three-dimensional, contrast-enhanced magnetic resonance imaging to capture anatomy and scar. Electrophysiologic behavior is then simulated to localize arrhythmia drivers, forecast recurrence risk, and define an optimal ablation strategy.

In the TWIN-VT trial, 10 participants with prior heart attacks and ventricular tachycardia underwent digital twin–guided ablation. Twin-predicted targets were imported into a catheter navigation system for use in the procedure room. The clinical team then performed ablation according to the preplanned strategy generated by each patient’s model.

Post-procedure, ventricular tachycardia was noninducible in all subjects, with two transient episodes during healing. At more than one year, all 10 patients remained free of recurrent arrhythmia, a 100% success rate compared with a typical long-term success rate of 60% for conventional ablation. Eight patients discontinued antiarrhythmic medication and two reduced doses. The approach also produced faster and more accurate procedures relative to traditional methods, as described in the report.

Medical digital twins are computer models that mimic organ behavior and provide predictive insights. The study, published in the New England Journal of Medicine on April 1, 2026, reported safety, feasibility, and promising outcomes. The team plans a larger clinical trial, is working to deliver desktop access that can return treatment plans within minutes, and intends to extend the technology to other cardiac diseases.

“For patients, digital twins can be life-changing and life-saving. We show we can make their procedures safer, shorter and more effective by targeting only the critical portions of the heart,” said Jonathan Chrispin, a cardiologist who specializes in treating arrhythmias at Johns Hopkins University.

“In the patient’s digital twin, we can try different scenarios for treatment before we treat the actual patient and provide the treating physician with the best, most optimal scenario, minimizing damage to the heart, and increasing the potential for a successful treatment. The digital twin allows us to address all potential sources of arrhythmias that may not be seen by clinical interrogation. We exhaust all possibilities,” said senior author Natalia Trayanova, the Murray B. Sacks professor of Biomedical Engineering at Johns Hopkins University.

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