Current trends in virtual electrophysiology use for risk stratification and treatment of ventricular arrhythmias

Currently efforts are being undertaken to establish and bring into clinical practice the field of virtual cardiac electrophysiology. The basic premise lies in acquiring an accurate whole-heart model based both on anatomy and electrophysiological properties of every myocardial voxel. Subsequently, one option is to perform a virtual electrophysiology study, with no constraints regarding site and number of extrasystoles in order to assess arrhythmogenic potential of the ventricle (ventricular arrhythmia risk prediction). The alternative, in cases with documented ventricular arrhythmia, would be to fine-tune the model into being able to simulate the clinical arrhythmia and then assess its mechanism, establishing vulnerable sites and thus ablation targets in order to guide the subsequent interventional procedure (virtual arrhythmia ablation targeting). Once clinical evidence supports vEP value in terms of accuracy and safety, it could be expected that even induced, nonclinical, arrhythmias could be targeted. Finally, advances in the field of computational power and artificial intelligence, including radiomics, along with stereotactic arrhythmia radioablation could render the future of arrhythmia management and treatment virtually unrecognizable in the not-so-distant future. The present mini review will attempt to familiarize clinicians with the tenets and current state of vEP, especially in the current phase where larger prospective clinical studies are required for further advancement, as well as offer a glimpse at potential future directions of this approach.