EVALUATING HEART DIGITAL TWINS IN GUIDING CATHETER ABLATION FOR VENTRICULAR TACHYCARDIA

Abstract Introduction Outcomes for catheter ablation of ventricular tachycardia (VT) are suboptimal with high recurrence rates. Magnetic Resonance Imaging (MRI)-based personalised heart digital twins may improve outcomes by non-invasively predicting VT circuits and optimum ablation lesion sites. We carried out this combined clinical and digital twins study, to assess the accuracy of digital twins in predicting critical substrate in VT. Methods 18 patients with scar-dependent VT underwent digital twin creation based on pre-procedural cardiac MRI. Using rapid pacing protocols, VT was simulated and ablation targets derived which terminate all possible VTs in the models. Patients subsequently underwent invasive VT ablation including targeting of abnormal electrograms, diastolic activity during VT and labelling of sites of VT termination with ablation. Digital twin-predicted VT circuits and ablation lesions were compared to their invasive clinical counterparts. Results 7699 invasive electrograms were analysed. Electrograms abnormalities were more frequently observed within digital twins-predicted areas compared to non-predicted areas (1116/2822 [39.5%] versus 1108/4877 [27.2%]) respectively (P < 0.001). Electrogram duration was significantly longer in the predicted areas (77.5 ms [± 25.8 ms] versus 65.7 ms [± 20.2 ms], P < 0.001). During VT, mid-diastolic potentials (a marker of the VT isthmus) were recorded in 16/43 (37.2%) of induced VTs. 13/16 (81.3%) of MDPs were located within 5 mm of a digital twin-predicted area vs 3/16 (18.8%) which were remote (P < 0.001). A total of 709 clinical radiofrequency lesions were delivered to terminate VT, of which 426/709 (60.1%) were within 5 mm of a digital twin-predicted target site. Conclusions Heart digital twin VT circuits and ablation targets accurately predict their respective clinical counterparts. Our findings demonstrate the immense potential of digital twin technology in guiding catheter ablation for scar-dependent VT.