How personalized heart modeling can help treatment of lethal arrhythmias: A focus on ventricular tachycardia ablation strategies in post‐infarction patients

Abstract

Precision Cardiology is a targeted strategy for cardiovascular disease prevention and treatment that accounts for individual variability. Computational heart modeling is one of the novel approaches that have been developed under the umbrella of Precision Cardiology. Personalized computational modeling of patient hearts has made strides in the development of models that incorporate the individual geometry and structure of the heart as well as other patient‐specific information. Of these developments, one of the potentially most impactful is the research aimed at noninvasively predicting the targets of ablation of lethal arrhythmia, ventricular tachycardia (VT), using patient‐specific models. The approach has been successfully applied to patients with ischemic cardiomyopathy in proof‐of‐concept studies. The goal of this paper is to review the strategies for computational VT ablation guidance in ischemic cardiomyopathy patients, from model developments to the intricacies of the actual clinical application. To provide context in describing the road these computational modeling applications have undertaken, we first review the state of the art in VT ablation in the clinic, emphasizing the benefits that personalized computational prediction of ablation targets could bring to the clinical electrophysiology practice. This article is characterized under: Analytical and Computational Methods > Computational Methods Models of Systems Properties and Processes > Organ, Tissue, and Physiological Models Translational, Genomic, and Systems Medicine > Translational Medicine

Electro-Mechanical Whole-Heart Digital Twins: A Fully Coupled Multi-Physics Approach

“…The first step to a personalized in silico model is to create an anatomically accurate representation of the heart in a discretized finite element model. Medical imaging data plays an important role in this step, since it provides the individuals shape of the heart and structural information such as the location of a scar, fiber architecture, and fibrosis in a noninvasive procedure [81,82]. In the case of whole heart models, a semi-automatic workflow has been proposed by Strocchi et al [39].…”

Ventricular Arrhythmias in Ischemic Cardiomyopathy—New Avenues for Mechanism-Guided Treatment

“…(C) MAP recording illustrating beat-to-beat variability of repolarisation, a functional substrate, is increased in the border zone during sympathetic stimulation (Adapted from [89]]). (D) Illustration of the fixed scar substrate: left, example of high-definition ex vivo cardiac magnetic resonance imaging highlighting the infarct (top) used to reconstruct the infarct in 3D (bottom); right reentrant mechanism of tachycardia utilizing channel of surviving myocytes in the BZ (Adapted from [90]).…”

“…Recent advanced imaging combined with computational studies in experimental MI large-animal models has allowed description of the heterogeneous fibrosis and myofibre disorganisation that is characteristic of reentry circuit areas [105,106]. This data has led to novel clinical ablation strategies based on detailed imaging analysis to predict arrhythmia ablation sites with initial reassuring success (Figure 4D) [90]. The prescribed approach to ablation of post-MI VT typically depends upon the induction of stable arrhythmia pacing manoeuvres, like pace-mapping and entrainment, to determine the ablation target [42,44].…”

A space-fractional bidomain framework for cardiac electrophysiology: 1D alternans dynamics

“…Understanding the complex dynamics underlying the multiscale features of excitable biological media is becoming of paramount importance in cardiac modelling, especially for personalised medical treatment [2,3]. The enormous effort that has been made to this day in theoretical, experimental, and clinical research in cardiac electrophysiology still has not been able to fully elucidate important issues and underlying mechanisms, such as cell-cell communication, emerging behaviors, irregular rhythms (alternans), and arrhythmias onset [4,5].…”