Non-invasive localization of post-infarct ventricular tachycardia exit sites to guide ablation planning: a computational deep learning platform utilizing the 12-lead electrocardiogram and intracardiac electrograms from implanted devices.

Autor:	Monaci S; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom., Qian S; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom., Gillette K; Medical University of Graz, Graz 8036, Austria., Puyol-Antón E; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom., Mukherjee R; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.; Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom., Elliott MK; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.; Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom., Whitaker J; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.; Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom., Rajani R; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.; Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom., O'Neill M; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom., Rinaldi CA; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.; Guy's and St Thomas' Hospital, London SE1 7EH, United Kingdom., Plank G; Medical University of Graz, Graz 8036, Austria., King AP; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom., Bishop MJ; Biomedical Engineering & Imaging Sciences, King's College London, London SE1 7EH, United Kingdom.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2023 Feb 16; Vol. 25 (2), pp. 469-477.
DOI:	10.1093/europace/euac178
Abstrakt:	Aims: Existing strategies that identify post-infarct ventricular tachycardia (VT) ablation target either employ invasive electrophysiological (EP) mapping or non-invasive modalities utilizing the electrocardiogram (ECG). Their success relies on localizing sites critical to the maintenance of the clinical arrhythmia, not always recorded on the 12-lead ECG. Targeting the clinical VT by utilizing electrograms (EGM) recordings stored in implanted devices may aid ablation planning, enhancing safety and speed and potentially reducing the need of VT induction. In this context, we aim to develop a non-invasive computational-deep learning (DL) platform to localize VT exit sites from surface ECGs and implanted device intracardiac EGMs. Methods and Results: A library of ECGs and EGMs from simulated paced beats and representative post-infarct VTs was generated across five torso models. Traces were used to train DL algorithms to localize VT sites of earliest systolic activation; first tested on simulated data and then on a clinically induced VT to show applicability of our platform in clinical settings. Localization performance was estimated via localization errors (LEs) against known VT exit sites from simulations or clinical ablation targets. Surface ECGs successfully localized post-infarct VTs from simulated data with mean LE = 9.61 ± 2.61 mm across torsos. VT localization was successfully achieved from implanted device intracardiac EGMs with mean LE = 13.10 ± 2.36 mm. Finally, the clinically induced VT localization was in agreement with the clinical ablation volume. Conclusion: The proposed framework may be utilized for direct localization of post-infarct VTs from surface ECGs and/or implanted device EGMs, or in conjunction with efficient, patient-specific modelling, enhancing safety and speed of ablation planning. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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