Clinical validation of an in silico pace mapping approach to localize both focal and re-entrant ventricular arrhythmias in patients with structural heart disease
Abstract
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) is characterized by long procedures and frequent recurrence. Personalized image-based computational models may provide noninvasive ablation target guidance but are computationally demanding and cannot localize focal arrhythmias. OBJECTIVE: This study aims to clinically validate our near real-time in silico pace mapping (InSPM) approach, which rapidly localizes both focal and re-entrant arrhythmia site of origins within personalized image-based models. METHODS: Personalized models incorporating scar were reconstructed from imaging data in 18 patients with structural heart disease; 12-lead electrocardiogram (ECGs) were obtained during clinical pace mapping and pacing site locations defined as ground truth. ECG templates of induced monomorphic VT were obtained. Virtual pacing was conducted in models and simulated ECGs correlated with clinical templates to produce high-resolution virtual pace-maps. Distance (d) between clinical ground truth sites and simulation predicted target areas with highest correlation quantitatively assessed InSPM accuracy for localizing focal activations. For re-entrant VT, predicted targets were compared with surrogates of VT site of origin and mapped VT circuits. RESULTS: Intrinsic resolution of clinical pace mapping was approximately 4 mm for similarly correlated ECGs (mean correlation coefficient >0.99). Across 270 clinical pace-mapping locations, d was 8.2 mm (6.9‒12 mm), relatively insensitive to cardiomyopathy, but with increased accuracy in right vs left ventricles. Patient-specific ECG electrodes alongside accurate scar representation, particularly in patients with ischemia, were important for optimizing InSPM accuracy. InSPM created from clinical ECG VT templates reliably identified re-entrant VT exit sites. CONCLUSION: InSPM provides a rapid and validated personalized computational modeling ablation technology to accurately localize both focal and re-entrant VTs, which may be practically integrated into clinical workflows.
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BibTeX
@article{campos2026clinical,
title = {{Clinical validation of an in silico pace mapping approach to localize both focal and re-entrant ventricular arrhythmias in patients with structural heart disease}},
author = {Fernando Campos and Ursula Rohrer and Sri Kousthubha Allampalli and Ali-Razak Rashid and Iulia Nazarov and Karli Gillette and Janneke Burger and Pranav Bhagirath and Robert Arnold and Luca Azzolin and Aurel Neic and Matthias Gsell and Mohammadreza Kariman and Tevfik Ismail and Ronak Rajani and Sebastien Roujol and Mark O’neill and Matthew Wright and Christopher Aldo Rinaldi and Gernot Plank and John Whitaker and Martin Bishop},
journal = {Heart Rhythm},
year = {2026},
month = oct,
doi = {10.1016/j.hrthm.2026.05.023},
url = {https://hal.science/hal-05795601v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Clinical validation of an in silico pace mapping approach to localize both focal and re-entrant ventricular arrhythmias in patients with structural heart disease
AU - Fernando Campos
AU - Ursula Rohrer
AU - Sri Kousthubha Allampalli
AU - Ali-Razak Rashid
AU - Iulia Nazarov
AU - Karli Gillette
AU - Janneke Burger
AU - Pranav Bhagirath
AU - Robert Arnold
AU - Luca Azzolin
AU - Aurel Neic
AU - Matthias Gsell
AU - Mohammadreza Kariman
AU - Tevfik Ismail
AU - Ronak Rajani
AU - Sebastien Roujol
AU - Mark O’neill
AU - Matthew Wright
AU - Christopher Aldo Rinaldi
AU - Gernot Plank
AU - John Whitaker
AU - Martin Bishop
PY - 2026
DA - 2026/10/12
JO - Heart Rhythm
DO - 10.1016/j.hrthm.2026.05.023
UR - https://hal.science/hal-05795601v1
AB - BACKGROUND: Catheter ablation of ventricular tachycardia (VT) is characterized by long procedures and frequent recurrence. Personalized image-based computational models may provide noninvasive ablation target guidance but are computationally demanding and cannot localize focal arrhythmias. OBJECTIVE: This study aims to clinically validate our near real-time in silico pace mapping (InSPM) approach, which rapidly localizes both focal and re-entrant arrhythmia site of origins within personalized image-based models. METHODS: Personalized models incorporating scar were reconstructed from imaging data in 18 patients with structural heart disease; 12-lead electrocardiogram (ECGs) were obtained during clinical pace mapping and pacing site locations defined as ground truth. ECG templates of induced monomorphic VT were obtained. Virtual pacing was conducted in models and simulated ECGs correlated with clinical templates to produce high-resolution virtual pace-maps. Distance (d) between clinical ground truth sites and simulation predicted target areas with highest correlation quantitatively assessed InSPM accuracy for localizing focal activations. For re-entrant VT, predicted targets were compared with surrogates of VT site of origin and mapped VT circuits. RESULTS: Intrinsic resolution of clinical pace mapping was approximately 4 mm for similarly correlated ECGs (mean correlation coefficient >0.99). Across 270 clinical pace-mapping locations, d was 8.2 mm (6.9‒12 mm), relatively insensitive to cardiomyopathy, but with increased accuracy in right vs left ventricles. Patient-specific ECG electrodes alongside accurate scar representation, particularly in patients with ischemia, were important for optimizing InSPM accuracy. InSPM created from clinical ECG VT templates reliably identified re-entrant VT exit sites. CONCLUSION: InSPM provides a rapid and validated personalized computational modeling ablation technology to accurately localize both focal and re-entrant VTs, which may be practically integrated into clinical workflows.
SN - 1547-5271
SN - 1556-3871
ER -