inEurHeart

AI-powered 3D mapping of the heart

The challenge

The leading cause of death in Europe, cardiovascular disease, claims 4 million lives every year and is set to increase with the aging population.[1] Cardiovascular disease is lambasting the European economy with an annual burden equivalent to €210 billion.[2]

Sudden cardiac death (SCD) represents a significant part of this burden. Up to 80% of these deaths are due to ventricular arrhythmia such as ventricular tachyarrhythmia (VT) and ventricular fibrillation (VF).[3] VT is a fast heart rate arising from the lower chambers of the heart and frequently recurs after catheter ablation.[4][5] VF is a serious heart rhythm problem in which the heart beats quickly and out of rhythm.

The success rate of therapy for complex and potentially life-threatening cardiac arrhythmia (irregular heartbeat) is low.[6][7] Catheter ablation is the go-to procedure to prevent arrhythmias in patients at risk of VT. [8][9][10]

Catheter ablation cauterises the areas of the heart responsible for the abnormal rhythm. But finding the culprit areas is difficult. To restore the heart’s natural rhythm and minimise the chances of VT recurrence, cauterising all areas responsible for arrhythmic events is essential.

For this reason, doctors spend most of the catheter ablation procedure time identifying ablation targets, and interventions can last 5 to 8 hours. [11][12][13]  This is currently done through the insertion of a mapping catheter into the heart.

Preoperative 3D imaging could provide information on ablation targets, but current tools are limited by low quality data and by the need for on-site data processing experts. In addition, current solutions are over-reliant on MRI, which is not available in most centres or usable for patients with implantable cardioverter defibrillators (ICDs).

Hospitals face managerial challenges as it is very difficult to predict how long these catheter ablations will last, which leads to inefficient management of human resources and space. A recent study estimated a first conventional catheter-based ablation to cost €9,099 per procedure in the UK.[14] Shortening these interventions would reduce their cost substantially.

The solution

The solution provided by inEurHeart is based on the inHEART solution (CE Marked), but with added functionality provided by AI which digitally twins the images the technology creates. The AI tools of inEurHEART means data can be processed much faster.

inHEART identifies detailed anatomy and ablation targets from raw patient images. This is an easy-to-implement, reproducible and scalable solution to guide VT ablation from pre-operative computed tomography (CT) images.

The 3D models inEurHeart will create can be displayed in 3D mapping systems, allowing cardiologists to navigate their ablation catheter in real time towards the identified targets. Compared to MRI, CT is widely available, more reproducible across vendors and sites, less hampered by defibrillator issues, and has higher spatial resolution, which is key to analyse scar tissue.

CT is already clinically recommended before VT ablation procedures, so the approach can easily be implemented within standard care. It has been already tested on 1500 patients.[15][16]

This solution alleviates the current shortcomings of VT ablation. The diagnostic part of the procedure can now happen before the ablation so that the doctor is entirely focused on therapy. Imaging allows for targets detection even deep in the myocardium (muscular layer of the heart), unlike mapping based on electrograms, with a much superior spatial resolution.

VT ablation becomes simpler and faster (potentially half the time), and more standardised. Shorter procedures mean fewer complications, improved cost-effectiveness and productivity of catheter ablation labs. [17][18][19]

This simpler approach becomes doable outside expert centres, increasing access to VT ablation and addressing global clinical needs. This solution promises to halve recurrence rates and increase the effectiveness of ablation procedures. [20][21]

Expected impact

inEurHeart promises to improve hospital and healthcare resource efficiency. In doing so, it can enable the treatment of more patients within expert and non-expert centres.

As inEurHeart makes ablation more affordable for healthcare payers, more patients can get access to a procedure that reduces life threatening arrhythmias and improves their quality of life and participation in society.

Ultimately, this project promises to improve patient management for these lethal arrhythmias, support hospitals with cost and time reductions for these complex interventions. It also has the potential to boost the EU economy through job creation and increased medical availability.

Project leaders

• InHeart

External partners

• Liryc – the Electrophysiology and Heart Modelling Institute (IHU Lyric), Bordeaux University 
• University of Bordeaux
• University Hospital Bordeaux

References

[1] Roberts-Thomson, K., et al. (2011). The diagnosis and management of ventricular arrhythmias. Nature Reviews Cardiology. 8(6), 311-321.

[2] Ehnheart.org. (2017). CVD Statistics 2017. Available at: https://ehnheart.org/cvd-statistics/cvd-statistics-2017.html

[3] Waldmann, V., et al. (2017). Mort subite de l’adulte : une meilleure compréhension pour une meilleure prévention. Annales De Cardiologie Et D’angéiologie, 66(4), 230-238.

[4] Tung, R., et al. (2015). Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart Rhythm, 12(9):1997-2007.

[5] Cheung, J., et al. (2018). Outcomes, Costs, and 30-Day Readmissions After Catheter Ablation of Myocardial Infarct–Associated Ventricular Tachycardia in the Real World. Circulation: Arrhythmia And Electrophysiology, 11(11).

[6]  Adabag, A., et al. (2010). Sudden cardiac death: epidemiology and risk factors. Nature Reviews Cardiology, 7(4), 216-225.

[7] Roberts-Thomson, K., et al. (2011). The diagnosis and management of ventricular arrhythmias. Nature Reviews Cardiology. 8(6), 311-321.

[8] Sapp J.L., et al. (2016). Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. The New England journal of medicine. 375(15), 1498-1500.

[9] Frankel, D., et al. (2011). Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 22:1123-8.

[10] Dinov, B., et al. (2014). Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long-term outcomes: results from the heart center of leipzig ventricular tachycardia registry. Circulation Arrhythmia and electrophysiology. 7:1144-51.

[11] Sapp J.L., et al. (2016). Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. The New England journal of medicine. 375(15), 1498-1500.

[12] Frankel, D., et al. (2011). Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 22:1123-8.

[13] Dinov, B., et al. (2014). Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long-term outcomes: results from the heart center of leipzig ventricular tachycardia registry. Circulation Arrhythmia and electrophysiology. 7:1144-51.

[14] Y, Chen., et al. (2020). Single-Image HDR Reconstruction by Learning to Reverse the Camera Pipeline, Collection of open conferences in research transport. Vol. 2020, 69. Available at: https://www.scipedia.com/public/Chen_et_al_2020a

[15] Cochet, H., et al. (2013). Integration of merged delayed-enhanced magnetic resonance imaging and multidetector computed tomography for the guidance of ventricular tachycardia ablation: a pilot study. J Cardiovasc Electrophysiol. 24:419-426

[16]Komatsu, Y., et al. (2013). Regional myocardial wall thinning at multidetector computed tomography correlates to arrhythmogenic substrate in postinfarction ventricular tachycardia: assessment of structural and electrical substrate. Circ Arrhythm Electrophysiol. 6:342-350

[17] Sapp J.L., et al. (2016). Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. The New England journal of medicine. 375(15), 1498-1500.

[18] Tung, R., et al. (2015). Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart Rhythm, 12(9):1997-2007.

[19] Kuck, KH., et al. (2010). Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. 375(9708):31-40.

[20] Yamashita, S., et al. (2016). Image Integration to Guide Catheter Ablation in Scar-Related Ventricular Tachycardia. J Cardiovasc Electrophysiol. 27:699-708

[21] Mahida, S., et al. (2017). Cardiac Imaging in Patients With Ventricular Tachycardia. Circulation. 136:2491-2507