Combining electrocardiographic imaging (ECGI) with cardiac digital twin technology enhances the accuracy of locating the origin of premature ventricular contractions (PVCs), offering a potential advance for personalised ablation strategies, a new study has found.
PVCs are common cardiac arrhythmias, affecting up to 75% of the general population, and may require therapy if symptomatic. Accurate localisation of PVC origins is important for planning catheter ablation, but conventional 12-lead ECG and standard ECGI techniques often fall short of the required accuracy, particularly due to anatomical variability and signal noise.
A cardiac digital twin approach to ECGI
To address this, researchers at the Gregorio Marañón General University Hospital in Madrid have developed an enhanced method that integrates ECGI-derived local activation time (LAT) maps with personalised cardiac digital twins (ECGI-DT) to improve PVC origin detection.
The method was tested on 75 simulated PVC cases and one clinical patient case. By matching simulated surface potentials to measured data, the algorithm iteratively refined the PVC origin estimate, achieving much greater accuracy than ECGI alone.
Using ECGI-DT, the average localisation error dropped from the 30.69 ± 23.71 mm achieved using ECGI alone to 7.81 ± 3.82 mm. Notably, ECGI-DT correctly identified the cardiac chamber (right or left ventricle) and tissue depth (endocardial vs epicardial) of PVCs in 100% of cases tested, compared to 75% using ECGI alone.
More precise PVC localisation
Outlining the clinical relevance of their findings, the authors noted how ‘ECGI-DT technology in the clinical management of PVCs can represent a major step in cardiology, creating a new paradigm in personalised cardiac care’.
By offering more precise PVC localisation, ECGI-DT could optimise ablation planning, minimise procedural times and reduce radiation exposure during such procedures.
The research team suggest that future studies should focus on expanding the cardiac digital twin database to account for greater patient anatomical variability and validating the technique in larger patient cohorts.
They also envision ECGI-DT as a powerful adjunct to conventional mapping tools, moving the field closer to truly personalised cardiac care.
Reference
Sánchez J et al. Enhancing premature ventricular contraction localization through electrocardiographic imaging and cardiac digital twins. Comput Biol Med 2025;190:109994.
