Digital twins and ECGI enhance accuracy in arrhythmia treatment

Millions of people around the world live with cardiac arrhythmias. Only in Spain, it is estimated that more than one million citizens suffer from them. Detecting and treating them accurately continues to be one of the great challenges of cardiovascular medicine. Now, a team from the Universitat Politècnica de València (UPV), belonging to the COR-ITACA group, has launched a new non-invasive method to locate the origin of premature ventricular contractions (PVC), one of the most frequent cardiac arrhythmias. The method combines electrocardiographic imaging (ECGI) with digital twins of the heart, which helps to improve the accuracy with which the focus where these arrhythmias originate can be identified.

The Gregorio Marañón General University Hospital, the spin-off Corify Care S.L., the Complutense University of Madrid, the Autonomous University of Barcelona, the Centre for Biomedical Research Network in Cardiovascular Diseases (CIBERCV) and the Institute of Biomedical Engineering of the Karlsruhe Institute of Technology (Germany) have also participated in its development. Their work has been published in the journal Computers in Biology and Medicine.

Next week, the COR-ITACA team and the company Corify Care will present these results at the EHRA 2025 (European Heart Rhythm Association) Congress, Europe's most important event on cardiac arrhythmias, which starts tomorrow in Vienna (Austria).

What makes it different?

Currently, conventional electrocardiography (ECG) is used to detect premature ventricular contractions (PVCs). However, as explained by the COR-ITACA group of the UPV, its results can be limited by anatomical differences between patients. 'Electrocardiographic imaging offers a more detailed view, but it also has certain limitations in accurately determining the exact point of origin of the arrhythmia. And this is what we achieve with our new method,' emphasises Andreu Climent

The system, devised by the team of Spanish and German researchers and clinicians, integrates ECGI with personalized heart simulations. "With this, we have created a "digital twin' capable of reproducing the electrical activity of the myocardium more faithfully,' adds María S. Guillem

How does it work?

To create the new method, the research team generated a database of more than 600 simulations of cardiac arrhythmias using detailed anatomical models of the torso and the heart. Using these simulations, they developed an algorithm that allows the arrhythmia focus to be located with an average accuracy of 7.8 mm, compared to the more than 30 mm error recorded with standard ECGI, all in a completely non-invasive way.

In addition to the simulations, the new method was applied in a real clinical case of a patient with an arrhythmia localised in the free wall of the left ventricle. The model based on ECGI and digital twins achieved an estimation of the focus with an error of 15.5 mm, well below the error of 36.7 mm recorded with conventional ECGI.

'Our method can facilitate planning interventions, such as catheter ablation, by reducing the need for invasive scans and shortening intervention times. It could be integrated as a support tool in the preoperative planning of ablations. And it would be especially useful in complex cases where other techniques are more limited, such as in arrhythmias originating in the septum or at the base of the ventricle,' adds Jorge Sánchez.

EPICA+: a step forward in cardiac diagnosis

The COR-ITACA group at the UPV is currently leading a new project called EPICA+, whose ultimate goal is to apply this method to many more arrhythmias and to apply it in clinical practice. To do this, they will integrate electrocardiographic images (ECGI) with artificial intelligence and digital heart twins. 'The combination of these three technologies will help to improve the diagnosis and treatment of cardiac arrhythmias,' says María Guillem, project coordinator together with Andreu M. Climent.

The project brings together a multidisciplinary team of engineers, clinicians and data scientists, who will draw on a database of more than 1,000 patients and 20,000 computational models. Clinical trials involving 144 patients will validate the technology with the aim of doubling treatment success rates and reducing costs.

EPICA+ represents a significant milestone in Spanish research. This project not only addresses one of the greatest challenges in cardiovascular medicine but also highlights the impact that integrating advanced technologies, such as artificial intelligence and computational modelling, can have on improving healthcare."

María S. Guillem

EPICA+ is funded by the Knowledge Generation 2023 programme of the Spanish State Research Agency.