Enhancing premature ventricular contraction localization through electrocardiographic imaging and cardiac digital twins

Premature ventricular contractions (PVCs) represent a common and clinically significant cardiac arrhythmia, contributing to a spectrum of cardiovascular disorders. Accurate localization of the origin of PVCs is essential for devising targeted therapeutic strategies and refining our comprehension of ventricular arrhythmogenesis. Traditionally, the 12-lead ECG has been the go-to diagnostic tool for PVCs. However, individual anatomical differences and inter-patient electrophysiology variability limit its effectiveness. This study presents a new method that combines electrocardiographic imaging (ECGI) with the concept of cardiac digital twins (ECGI-DT) to improve the accuracy of pinpointing the source of PVCs. By simulating a database of PVCs, we developed an ECGI-DT capable of estimating the origins of PVCs with much greater precision than possible previously. This study shows a notable improvement in identifying the initial site of PVC origin using ECGI-DT compared to ECGI alone: the average localization error dropped from 30.69 ± 23.71 mm with standard ECGI to 7.81 ± 3.82 mm using the ECGI-DT method. This marked reduction in error highlights the potential of ECGI-DT in revolutionizing PVC diagnosis and treatment. With its ability to provide more accurate and reliable data, ECGI-DT could improve the planning of catheter ablation treatments, a preferred intervention for managing PVCs that face challenges such as high costs and in some cases long procedure times.