A computational study on the influence of antegrade accessory pathway location on the 12-lead electrocardiogram in Wolff-Parkinson-White syndrome
Autor(in); Institution
Gillette, Karli; Division of Biophysics and Medical Physics, Gottfried Schatz Research Center, Medical University of Graz, Graz, AUSTRIA
Winkler, Benjamin; 8.4, Mathematische Modellierung und Datenanalyse, PTB-Berlin
Kurath-Koller, Stefan; Division of Pediatric Cardiology, Department of Pediatrics, Medical University of Graz, Graz, AUSTRIA
Scherr, Daniel; Department of Cardiology, Medical University of Graz, Graz, AUSTRIA
Vigmond, Edward J; IHU Institut LIRYC, Fondation University Bordeaux, Talence, FRANCE; Institute of Mathematics of Bordeaux, University Bordeaux, Talence, FRANCE
Bär, Markus; 8.4, Mathematische Modellierung und Datenanalyse, PTB-Berlin; Institute of Theoretical Physics, Technische Universität, Berlin, GERMANY
Plank, Gernot; Division of Biophysics and Medical Physics, Gottfried Schatz Research Center, Medical University of Graz, Graz, AUSTRIA
Wolff-Parkinson-White Syndrome ; Cardiac Digital Twins ; 12 Lead ECG ; Uncertainty Quantification ; Sensitivity Analysis ; Accessory Pathways ; Virtual Models of Cardiac Electrophysiology
Zusammenfassung
Wolff-Parkinson-White syndrome is a cardiovascular disease characterized by abnormal atrio-ventricular conduction facilitated by accessory pathways (APs). Invasive catheter ablation of the AP represents the primary treatment modality. Accurate localization of APs is crucial for successful ablation outcomes, but current diagnostic algorithms based on the 12 lead electrocardiogram (ECG) often struggle with precise determination of AP locations. In order to gain insight into the mechanisms underlying localization failures observed in current diagnostic algorithms, we employ a virtual cardiac model to elucidate the relationship between AP location and ECG morphology. We first introduce a cardiac model of electrophysiology that was specifically tailored to represent antegrade APs in the form of a short atrio-ventricular bypass tract. Locations of antegrade APs were then automatically swept across both ventricles in the virtual model to generate a synthetic ECG database consisting of 9271 signals. Regional grouping of antegrade APs revealed overarching morphological patterns originating from diverse cardiac regions. We then applied variance-based sensitivity analysis relying on polynomial chaos expansion on the ECG database to mathematically quantify how variation in AP location and timing relates to morphological variation in the 12 lead ECG. We utilized our mechanistic virtual model to showcase limitations of AP localization using standard ECG-based algorithms and provide mechanistic explanations through exemplary simulations. Our findings highlight the potential of virtual models of cardiac electrophysiology not only to deepen our understanding of the underlying mechanisms of Wolff-Parkinson-White syndrome but also to potentially enhance the diagnostic accuracy of ECG-based algorithms and facilitate personalized treatment planning.
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Open Access Gold
Rechteinformation
CC BY 4.0 ; Creative Commons Attribution 4.0 License
Themenbereich der Metrologie
Metrologie in der Medizin
Zitierung
Gillette, K., Winkler, B., Kurath-Koller, S., Scherr, D., Vigmond, E. J., Bär, M., & Plank, G. (2025). A computational study on the influence of antegrade accessory pathway location on the 12-lead electrocardiogram in Wolff-Parkinson-White syndrome. EP Europace, 27(2), 1–13. https://doi.org/10.1093/europace/euae223
