A data-driven computational methodology for assessing ventricular ablation procedures

Figures

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  Fig. 1. A Schematic of ventricular endocardial surface in a post-infarction patient, illustrating the reentrant VT circuit (pre-ablation) case and its suppression (post-ablation). Isthmus is bounded by conduction block or slowed conduction zones: healthy myocardium (pink), border zone (gray), and dense scar (black). Purple arrows indicate the propagation loop involving entrance, isthmus, and exit sites. B Corresponding CARTO sinus rhythm maps displaying bipolar voltage, with overlaid positions of the mapping electrode (white dots) during data acquisition. C Local activation time (LAT), where low-voltage regions (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\le 1\,\text {mV}$$\end{document}≤1mV) and delayed activation times overlap with anatomical isthmus. D CARTO-based reconstructions showing electrical isolation of the reentrant pathway, with E ablated regions highlighted in blue

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  Fig. 2. Schematic overview of the pipeline used to obtain the ventricular computational domain. A Regularized left ventricular geometry: Black dots indicate the locations of the three S1 stimuli (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\text {S1}j$$\end{document}S1j, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$j \in \{1, 2, 3\}$$\end{document}j∈{1,2,3}) used to reproduce sinus endocardial activation. B Impairing function \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$F(\textbf{x})$$\end{document}F(x) distinguishing the scar core (dark blue) from the working myocardium (red). C Detail of the local wall thickness…

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  Fig. 3. A Comparison between in vivo and in silico EGMs (for \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\alpha =0.5, 0.65, 0.8$$\end{document}α=0.5,0.65,0.8) in four representative measurement points around the scar region. Horizontal and vertical dashed lines indicate, respectively, the maximum/minimum amplitude and deflection points of the EGM. B In silico LAT map from the monodomain simulations, with superimposed measurement locations of the EGMs taken from CARTO. The larger circles indicate the four locations corresponding to the EGMs reported in (A). C Electrical diffusivity field \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\textbf{D}(\textbf{x})$$\end{document}D(x) where the gray region corresponds to the scar core. D CV streamlines colored by its magnitude. E APD map on the ventricle endocardium

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  Fig. 4. Time evolution of the induced reentry following the application of the S2a stimulus. The light blue arrows indicate the direction of wavefront propagation

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  Fig. 5. A Positions of the clinical points (with their relative ID). B Details of the cross section of the ablated volume for different values of local ablation radius, namely \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R=3.5, 7.5,10\,\text {mm}$$\end{document}R=3.5,7.5,10mm. Time evolution of the post-intervention reentry induced through S1-S2 procedure (ectopic beat S2a) for different values of the local ablation radius: C \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R=3.5\,\text {mm}$$\end{document}R=3.5mm, D \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$R=7.5\,\text {mm}$$\end{document}R=7.5mm, E \documentclass[12pt]{minimal}…

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  Fig. 6. Time evolution of the post-intervention reentry induced through S1-S2 procedure for different positions of the ectopic beat: A S2b, B S2c and C S2d. The corresponding number of vortex cores in time is reported in D

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  Fig. 7. Time evolution of the post-intervention reentry induced through S1-S2 (S2=S2a) procedure for A LAT- B CV- and C APD-guided ablation procedures. D Time evolution of the corresponding number of vortex cores

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  Fig. 8. Comparision between MRI slices acquired in vivo vs geometry slices obtained in silico for (A1, A2) distal, (B1, B2) medial and (C1, C2) proximal portion of the ventricle in the long-axis direction. Measuring lines are reported in magenta for the scar region and in orange for the working myocardium, respectively

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  Fig. 9. Locations of the ectopic S2 stimulus overlaid on the endocardial surface: A S2a with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau _{\text {S2}}=285\,\text {ms}$$\end{document}τS2=285ms, B S2b with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau _{\text {S2}}=325\,\text {ms}$$\end{document}τS2=325ms, C S2c with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\tau _{\text {S2}}=350\,\text {ms}$$\end{document}τS2=350ms and D S2d with \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek}…

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  Fig. 10. Same as Fig. 7, but for S2=S2b

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  Fig. 11. Same as Fig. 7, but for S2=S2c. The empty final panel indicates the absence of vortices, with the counter remaining at zero

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  Fig. 12. Same as Fig. 7, but for S2=S2d