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Introduction: Various left atrial (LA) anatomical structures are correlated with postablative recurrence for atrial fibrillation (AF) patients. Comprehensively integrating anatomical structures, digitizing them, and implementing in‐depth analysis, which may supply new insights, are needed. Thus, we aim to establish an interpretable model to identify AF patients' phenotypes according to LA anatomical morphology, using machine learning techniques. Methods and Results: Five hundred and nine AF patients underwent first ablation treatment in three centers were included and were followed‐up for postablative recurrent atrial arrhythmias. Data from 369 patients were regarded as training set, while data from another 140 patients, collected from different centers, were used as validation set. We manually measured 57 morphological parameters on enhanced computed tomography with three‐dimensional reconstruction technique and implemented unsupervised learning accordingly. Three morphological groups were identified, with distinct prognosis according to Kaplan−Meier estimator (p <.001). Multivariable Cox model revealed that morphological grouping were independent predictors of 1‐year recurrence (Group 1: HR = 3.00, 95% CI: 1.51−5.95, p =.002; Group 2: HR = 4.68, 95% CI: 2.40−9.11, p <.001; Group 3 as reference). Furthermore, external validation consistently demonstrated our findings. Conclusions: Our study illustrated the feasibility of employing unsupervised learning for the classification of LA morphology. By utilizing morphological grouping, we can effectively identify individuals at different risks of postablative recurrence and thereby assist in clinical decision‐making. [ABSTRACT FROM AUTHOR]

Summary: Complex fragment atrial electrograms (CFAEs) are fractionated or discrete atrial wave fronts that frequently mapped in chronic atrial fibrillation (CAF). The CFAEs areas represent slow conduction and/or functional blocks that play substrate role in AF. Compared with the limited efficacy of pulmonary veins (PVs) oriented ablation strategy for CAF, few attempts of adjunctive ablation on CFAEs gain promising outcome. We hypothesized that CFAEs, not PVs, are the ideal ablation targets for CAF. [Copyright &y& Elsevier]