Rotors exhibit greater surface ECG variation during ventricular fibrillation than focal sources due to wavebreak, secondary rotors, and meander

Ho, Gordon; Villongco, Christopher T.; Yousefian, Omid; Bradshaw, Aaron; Nguyen, Andrew; Faiwiszewski, Yonatan; Hayase, Justin; Rappel, Wouter‐Jan; McCulloch, Andrew D.; Krummen, David E.

doi:10.1111/jce.13283

Cited by 10 publications

(6 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rapid advancements in computer performance have enabled detailed, physiologically realistic whole-heart simulations of cardiac arrhythmias 8,9 and pacing. 10 Proof-of-concept work has demonstrated the feasibility of the forward-solution computational mapping approach which compares patient ECG data to a precomputed set of monodomain model arrhythmia simulations 11 to predict sites of origin for refractory ventricular tachycardia (VT).…”

mentioning

confidence: 99%

Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study

Krummen

Villongco

et al. 2022

Circ: Arrhythmia and Electrophysiology

Self Cite

View full text Add to dashboard Cite

Background: The accuracy of noninvasive arrhythmia source localization using a forward-solution computational mapping system has not yet been evaluated in blinded, multicenter analysis. This study tested the hypothesis that a computational mapping system incorporating a comprehensive arrhythmia simulation library would provide accurate localization of the site-of-origin for atrial and ventricular arrhythmias and pacing using 12-lead ECG data when compared with the gold standard of invasive electrophysiology study and ablation. Methods: The VMAP study (Vectorcardiographic Mapping of Arrhythmogenic Probability) was a blinded, multicenter evaluation with final data analysis performed by an independent core laboratory. Eligible episodes included atrial and ventricular: tachycardia, fibrillation, pacing, premature atrial and ventricular complexes, and orthodromic atrioventricular reentrant tachycardia. Mapping system results were compared with the gold standard site of successful ablation or pacing during electrophysiology study and ablation. Mapping time was assessed from time-stamped logs. Prespecified performance goals were used for statistical comparisons. Results: A total of 255 episodes from 225 patients were enrolled from 4 centers. Regional accuracy for ventricular tachycardia and premature ventricular complexes in patients without significant structural heart disease (n=75, primary end point) was 98.7% (95% CI, 96.0%–100%; P <0.001 to reject predefined H 0 <0.80). Regional accuracy for all episodes (secondary end point 1) was 96.9% (95% CI, 94.7%–99.0%; P <0.001 to reject predefined H 0 <0.75). Accuracy for the exact or neighboring segment for all episodes (secondary end point 2) was 97.3% (95% CI, 95.2%–99.3%; P <0.001 to reject predefined H 0 <0.70). Median spatial accuracy was 15 mm (n=255, interquartile range, 7–25 mm). The mapping process was completed in a median of 0.8 minutes (interquartile range, 0.4–1.4 minutes). Conclusions: Computational ECG mapping using a forward-solution approach exceeded prespecified accuracy goals for arrhythmia and pacing localization. Spatial accuracy analysis demonstrated clinically actionable results. This rapid, noninvasive mapping technology may facilitate catheter-based and noninvasive targeted arrhythmia therapies. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04559061.

show abstract

mentioning

confidence: 99%

Forward-Solution Noninvasive Computational Arrhythmia Mapping: The VMAP Study

Krummen

Villongco

et al. 2022

Circ: Arrhythmia and Electrophysiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Here, the goal is to investigate a question of interest about, for example, cardiac function or a drug/device, using a virtual cohort of PSMs that has been generated from data from several real patients. Examples include investigating ventricular fibrillation (VF) mechanisms [ 19 ], CRT efficacy [ 20 ], implantable cardioverter defibrillator efficacy [ 21 ], or to understand mechanisms related to CRT safety [ 22 ]…”

Section: Review Of Cardiac Electrophysiological Psms and Vvuq Applied...mentioning

confidence: 99%

“…Typically, a rule-based method is used to generate a fiber map for the patient’s anatomy [ 13 , 22 , 31 ]. An alternative method is to generate fibers for a different heart using DT-MRI and map those fibers to the patient’s anatomy [ 19 , 32 ]. These approaches could be considered as ‘semi-personalization’; while the fibers fields are not derived directly from patient data, they differ across patients and are dependent on the patient’s specific imaging data.…”

Section: Review Of Cardiac Electrophysiological Psms and Vvuq Applied...mentioning

confidence: 99%

Credibility assessment of patient-specific computational modeling using patient-specific cardiac modeling as an exemplar

Galappaththige

Gray²,

Costa³

et al. 2022

PLoS Comput Biol

View full text Add to dashboard Cite

Reliable and robust simulation of individual patients using patient-specific models (PSMs) is one of the next frontiers for modeling and simulation (M&S) in healthcare. PSMs, which form the basis of digital twins, can be employed as clinical tools to, for example, assess disease state, predict response to therapy, or optimize therapy. They may also be used to construct virtual cohorts of patients, for in silico evaluation of medical product safety and/or performance. Methods and frameworks have recently been proposed for evaluating the credibility of M&S in healthcare applications. However, such efforts have generally been motivated by models of medical devices or generic patient models; how best to evaluate the credibility of PSMs has largely been unexplored. The aim of this paper is to understand and demonstrate the credibility assessment process for PSMs using patient-specific cardiac electrophysiological (EP) modeling as an exemplar. We first review approaches used to generate cardiac PSMs and consider how verification, validation, and uncertainty quantification (VVUQ) apply to cardiac PSMs. Next, we execute two simulation studies using a publicly available virtual cohort of 24 patient-specific ventricular models, the first a multi-patient verification study, the second investigating the impact of uncertainty in personalized and non-personalized inputs in a virtual cohort. We then use the findings from our analyses to identify how important characteristics of PSMs can be considered when assessing credibility with the approach of the ASME V&V40 Standard, accounting for PSM concepts such as inter- and intra-user variability, multi-patient and “every-patient” error estimation, uncertainty quantification in personalized vs non-personalized inputs, clinical validation, and others. The results of this paper will be useful to developers of cardiac and other medical image based PSMs, when assessing PSM credibility.

show abstract

“…Noninvasive localization has been applied to channelopathies such as Brugada syndrome, 22 to guide cardiac resynchronization therapy to identify epicardial sites of latest activation, 23 and to identify localized rotational and focal circuits for VF 24 referenced to contact mapping. 25,26 Noninvasive localization is also applied to guide ablation of atrial fibrillation 27 with similar issues of resolution and preprocedural imaging and may identify critical sites for AF 28 using approaches to ECGI including reduced electrode methods and without pre-procedural imaging.…”

Section: Other Applications Of Noninvasive Arrhythmia Localizationmentioning

confidence: 99%