A topologically realistic Purkinje-based model successfully replaced a simpler fascicle-based model in a cardiac digital twin, preserving predominant ECG morphology under sinus rhythm.
An automated two-stage approach for generating personalized His-Purkinje system models in cardiac digital twins successfully preserves ECG morphology under sinus rhythm while revealing physiological differences during pacing.
Personalized models of cardiac electrophysiology (EP) that match clinical observation with high fidelity, referred to as cardiac digital twins (CDTs), show promise as a tool for tailoring cardiac precision therapies. Building CDTs of cardiac EP relies on the ability of models to replicate the ventricular activation sequence under a broad range of conditions. Of pivotal importance is the His-Purkinje system (HPS) within the ventricles. Workflows for the generation and incorporation of HPS models are needed for use in cardiac digital twinning pipelines that aim to minimize the misfit between model predictions and clinical data such as the 12 lead electrocardiogram (ECG). We thus develop an automated two stage approach for HPS personalization. A fascicular-based model is first introduced that modulates the endocardial Purkinje network. Only emergent features of sites of earliest activation within the ventricular myocardium and a fast-conducting sub-endocardial layer are accounted for. It is then replaced by a topologically realistic Purkinje-based representation of the HPS. Feasibility of the approach is demonstrated. Equivalence between both HPS model representations is investigated by comparing activation patterns and 12 lead ECGs under both sinus rhythm and right-ventricular apical pacing. Predominant ECG morphology is preserved by both HPS models under sinus conditions, but elucidates differences during pacing.
Gillette et al. (Tue,) conducted a other in Healthy (Cardiac electrophysiology modeling) (n=1). Purkinje-based His-Purkinje system model vs. Fascicular-based His-Purkinje system model was evaluated on Equivalence of activation patterns and 12-lead ECG morphology. A topologically realistic Purkinje-based model successfully replaced a simpler fascicle-based model in a cardiac digital twin, preserving predominant ECG morphology under sinus rhythm.