MINI REVIEW article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
This article is part of the Research TopicInnovative Approaches for Predicting and Reducing Sudden Cardiac Death in Early-Stage Cardiomyopathy Patients with Well-Maintained Systolic Ventricular FunctionView all articles
Current trends in virtual electrophysiology use for risk stratification and treatment of ventricular arrhythmias
Provisionally accepted
Christos-Konstantinos Antoniou1*
Konstantinos Karabinos1
Dimitris Tsiachris1
Athanasios Kordalis1
Petros Arsenos1
Ioannis Doundoulakis1
Polychronis Dilaveris2
Nikias Milaras3Skevos Sideris3
Ourania Kariki4
Alexandros Kasiakogias1Charalambos Vlachopoulos1
Konstantinos Toutouzas1
KONSTANTINOS P. TSIOUFIS1
Konstantinos Athanasios Gatzoulis1- 1First Department of Cardiology Athens Medical School, Hippokration General Hospital, Athens, Greece
- 2Third Department of Cardiology Athens Medical School, Sotiria General Hospital, Athens, Greece
- 3State Department of Cardiology, Hippokration General Hospital, Athens, Greece
- 4Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
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Currently. efforts are being undertaken to establish and bring into clinical practice the field of virtual cardiac electrophysiology. The basic premise lies in acquiring an accurate whole-heart model based both on anatomy and electrophysiological properties of every myocardial voxel. Subsequently, one option is to perform a virtual electrophysiology study, with no constraints regarding site and number of extrasystoles in order to assess arrhythmogenic potential of the ventricle (ventricular arrhythmia risk prediction). The alternative, in cases with documented ventricular arrhythmia, would be to fine-tune the model into being able to simulate the clinical arrhythmia and then assess its mechanism, establishing vulnerable sites and thus ablation targets in order to guide the subsequent interventional procedure (virtual arrhythmia ablation targeting). Once clinical evidence supports vEP value in terms of accuracy and safety, it could be expected that even induced, nonclinical, arrhythmias could be targeted. Finally, advances in the field of computational power and artificial intelligence, including radiomics, along with stereotactic arrhythmia radioablation could render the future of arrhythmia management and treatment virtually unrecognizable in the not-so-distant future. The present mini review will attempt to familiarize clinicians with the tenets and current state of vEP, especially in the current phase where larger prospective clinical studies are required for further advancement, as well as offer a glimpse at potential future directions of this approach.
Keywords: Cardiac simulation, virtual electrophysiology, Arrhythmic risk stratification, ventricular arrhythmia ablation, artificial intelligence
Received: 19 Sep 2025; Accepted: 04 Nov 2025.
Copyright: © 2025 Antoniou, Karabinos, Tsiachris, Kordalis, Arsenos, Doundoulakis, Dilaveris, Milaras, Sideris, Kariki, Kasiakogias, Vlachopoulos, Toutouzas, TSIOUFIS and Gatzoulis. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Christos-Konstantinos Antoniou, ckantoniou@hotmail.gr
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