Nonlinear electrocardiographic imaging using polynomial approximation networks

Hybrid Neural State-Space Modeling for Supervised and Unsupervised Electrocardiographic Imaging

State-space modeling (SSM) provides a general framework for many image reconstruction tasks. Error in a priori physiological knowledge of the imaging physics, can bring incorrectness to solutions. Modern deep-learning approaches show great promise but lack interpretability and rely on large amounts of labeled data. In this paper, we present a novel hybrid SSM framework for electrocardiographic imaging (ECGI) to leverage the advantage of state-space formulations in data-driven learning. We first leverage the physics-based forward operator to supervise the learning. We then introduce neural modeling of the transition function and the associated Bayesian filtering strategy. We applied the hybrid SSM framework to reconstruct electrical activity on the heart surface from body-surface potentials. In unsupervised settings of both in-silico and in-vivo data without cardiac electrical activity as the ground truth to supervise the learning, we demonstrated improved ECGI performances of the hybrid SSM framework trained from a small number of ECG observations in comparison to the fixed SSM. We further demonstrated that, when in-silico simulation data becomes available, mixed supervised and unsupervised training of the hybrid SSM achieved a further 40.6% and 45.6% improvements, respectively, in comparison to traditional ECGI baselines and supervised data-driven ECGI baselines for localizing the origin of ventricular activations in real data.

Electrocardiographic Imaging for Atrial Fibrillation: A Perspective From Computer Models and Animal Experiments to Clinical Value

Electrocardiographic imaging (ECGI) is a technique to reconstruct non-invasively the electrical activity on the heart surface from body-surface potential recordings and geometric information of the torso and the heart. ECGI has shown scientific and clinical value when used to characterize and treat both atrial and ventricular arrhythmias. Regarding atrial fibrillation (AF), the characterization of the electrical propagation and the underlying substrate favoring AF is inherently more challenging than for ventricular arrhythmias, due to the progressive and heterogeneous nature of the disease and its manifestation, the small volume and wall thickness of the atria, and the relatively large role of microstructural abnormalities in AF. At the same time, ECGI has the advantage over other mapping technologies of allowing a global characterization of atrial electrical activity at every atrial beat and non-invasively. However, since ECGI is time-consuming and costly and the use of electrical mapping to guide AF ablation is still not fully established, the clinical value of ECGI for AF is still under assessment. Nonetheless, AF is known to be the manifestation of a complex interaction between electrical and structural abnormalities and therefore, true electro-anatomical-structural imaging may elucidate important key factors of AF development, progression, and treatment. Therefore, it is paramount to identify which clinical questions could be successfully addressed by ECGI when it comes to AF characterization and treatment, and which questions may be beyond its technical limitations. In this manuscript we review the questions that researchers have tried to address on the use of ECGI for AF characterization and treatment guidance (for example, localization of AF triggers and sustaining mechanisms), and we discuss the technological requirements and validation. We address experimental and clinical results, limitations, and future challenges for fruitful application of ECGI for AF understanding and management. We pay attention to existing techniques and clinical application, to computer models and (animal or human) experiments, to challenges of methodological and clinical validation. The overall objective of the study is to provide a consensus on valuable directions that ECGI research may take to provide future improvements in AF characterization and treatment guidance.