In-silico pace-mapping using a detailed whole torso model and implanted electronic device electrograms for more
Sofia Monaci1, Marina Strocchi1, Cristobal Rodero1
1King's College London, London, United Kingdom.
Computers in Biology and Medicine
|September 24, 2020
Summary
In-silico pace-mapping using electrograms from implanted devices can identify ventricular tachycardia (VT) exit sites. This computational approach aids in pre-procedural planning for VT ablation, improving accuracy and efficiency.
Area of Science:
- Computational electrophysiology
- Medical imaging
- Cardiac electrophysiology
Background:
- Pace-mapping is a standard electrophysiological procedure to identify ventricular tachycardia (VT) exit sites.
- Current pace-mapping techniques are limited by long procedure times and the necessity for VT induction.
- In-silico pace-mapping offers a novel approach using stored electrogram (EGM) recordings for pre-procedural ablation planning.
Purpose of the Study:
- To demonstrate the potential of in-silico pace-mapping for guiding pre-procedural ablation planning.
- To evaluate the efficacy of using stored clinical VT EGMs for identifying VT exit sites and isthmuses.
- To compare the performance of ECG-based and EGM-based pace-mapping, including reference-less approaches.
Main Methods:
- Simulated six scar-related VT episodes in a 3D torso model derived from CT imaging.
- Utilized 12-lead ECG signals and various EGM sensing vectors from implanted devices for in-silico pace-mapping.
- Created conventional correlation maps and reference-less maps to localize VT exit sites and isthmuses.
Main Results:
- The in-silico platform successfully identified VT exit sites across different VT morphologies using both ECG and EGM maps.
- EGM-based pace-mapping performance correlated with the number of sensing vectors used.
- Reference-less pace-mapping (ECG and EGM) effectively identified slow-conducting isthmuses, with optimal algorithm parameters determined.
- EGM-based pace-mapping showed dependency on the mapped surface (epicardial/endocardial) relative to VT origin.
Conclusions:
- In-silico pace-mapping, combined with EGMs from implanted devices, is a viable strategy for localizing VT ablation targets.
- This computational method can significantly aid in pre-procedural planning for VT ablation.
- The study highlights the utility of both ECG and EGM data for precise VT localization in a virtual environment.
