Computational techniques based on cardiac data can help improve arrhythmia treatment

The electrical activation of the heart is a complex physiological process that is essential for understanding various cardiac dysfunctions, such as ventricular tachycardia (VT). Radiofrequency ablation of certain parts of the cardiac tissue to isolate the electrical circuits that cause these arrhythmias has proven to be the most successful treatment technique so far.

Electro-anatomical mapping provides clinicians with crucial information on ventricular activity to guide cardiac radiofrequency ablation treatment. The procedure can be quite long if there is no prior information on the patient's cardiac status, and it can be difficult to find the origin of anomalies in the cardiac electrical conduction pathway.

In the heart's electrical conduction system, Purkinje fibres are involved in the ventricular depolarization that enables the transmission of electrical signals primarily from the sinus node. However, the Purkinje system is very difficult to interpret from electro-anatomical maps.

Now, a study published in the journal Medical Image Analysis, led by Óscar Cámara and coordinated by the PhySense research group in the UPF Department of Information and Communication Technologies (DTIC), with RubénCárdenes and David Soto-Iglesias, as members of the team, has proposed a new method for reconstructing the fast electrical pathways of the heart's left ventricle that can provide very valuable clinical information to guide radiofrequency ablation treatments in patients with VT.

The researchers Rafael Sebastián, from the University of Valencia, and Antonio Berruezo, from Hospital Clínic in Barcelona, collaborated on the research and co-authored the paper.

A method for estimating the heart's electrical 'highways'

The study developed advanced computational methods based on estimating the minimal-cost geodesic pathways on patients' electro-anatomical maps. The new method for estimating the heart's electrical 'highways' was validated with realistic electro-physical simulations and applied to clinical cases of fascicular VT, providing physicians with clinical hitherto unavailable clinical data, thereby enabling considerably improved planning for procedures involving the Purkinje system.

The method proposed in the paper 'could help with surgical radiofrequency ablation in the treatment of VT', said Cámara. Moreover, according to Cárdenes, the paper's lead author, 'the electrophysiological data obtained with our method can easily be adapted for use with electrocardiographic data in order to enhance planning for cardiac resynchronization therapy in patients with myocardial infarction.'

This research was partially funded by the Carlos III Health Institute (ISCIII) (FIS - PI111/01709), the Spanish Ministry of Economy and Competitiveness (TIN2011-28067 and TIN2012-35874) and the Valencian government (GV/2013/094).

Paper:

Rubén Cárdenes, Rafael Sebastián, David Soto-Iglesias, Antonio Berruezo, Óscar Cámara. (2015). ' Estimation of Purkinje trees from electro-anatomical mapping of the left ventricle using minimal cost geodesics'. Medical Image Analysis, vol. 24, pp. 52-62.

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