Key result
Novel computational framework demonstrates feasibility for evaluating cardiac mapping systems using new activation pattern metrics.
Why the study?
Evaluating clinical cardiac mapping systems is difficult because transmembrane potentials cannot be recorded throughout the entire heart during procedures, preventing comparison to a gold standard.
A computational modeling framework using virtual electrode arrays and simulated cardiac patterns offers a novel, rigorous method for evaluating the accuracy of clinical cardiac mapping systems.
May refine mapping system evaluation in simulations; leaves open clinical translation and validation.
There are a variety of difficulties in evaluating clinical cardiac mapping systems, most notably the inability to record the transmembrane potential throughout the entire heart during patient procedures which prevents the comparison to a relevant "gold standard". Cardiac mapping systems are comprised of hardware and software elements including sophisticated mathematical algorithms, both of which continue to undergo rapid innovation. The purpose of this study is to develop a computational modeling framework to evaluate the performance of cardiac mapping systems. The framework enables rigorous evaluation of a mapping system's ability to localize and characterize (i.e., focal or reentrant) arrhythmogenic sources in the heart. The main component of our tool is a library of computer simulations of various dynamic patterns throughout the entire heart in which the type and location of the arrhythmogenic sources are known. Our framework allows for performance evaluation for various electrode configurations, heart geometries, arrhythmias, and electrogram noise levels and involves blind comparison of mapping systems against a "silver standard" comprised of computer simulations in which the precise transmembrane potential patterns throughout the heart are known. A feasibility study was performed using simulations of patterns in the human left atria and three hypothetical virtual catheter electrode arrays. Activation times (AcT) and patterns (AcP) were computed for three virtual electrode arrays: two basket arrays with good and poor contact and one high-resolution grid with uniform spacing. The average root mean squared difference of AcTs of electrograms and those of the nearest endocardial action potential was less than 1 ms and therefore appears to be a poor performance metric. In an effort to standardize performance evaluation of mapping systems a novel performance metric is introduced based on the number of AcPs identified correctly and those considered spurious as well as misclassifications of arrhythmia type; spatial and temporal localization accuracy of correctly identified patterns was also quantified. This approach provides a rigorous quantitative analysis of cardiac mapping system performance. Proof of concept of this computational evaluation framework suggests that it could help safeguard that mapping systems perform as expected as well as provide estimates of system accuracy.
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Galappaththige et al. (2023) studied Cardiac arrhythmias. Computational modeling framework (MSEF) was evaluated on Activation Time Performance Metric (AcTPM) and Activation Pattern Performance Metric (AcPPM). A novel computational modeling framework demonstrated feasibility in evaluating cardiac mapping systems, introducing new performance metrics based on correctly identified activation patterns.
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