Digital twins for cardiac electrophysiology: state of the art and future challenges.

Q4 Medicine Herzschrittmachertherapie und Elektrophysiologie Pub Date : 2024-06-01 Epub Date: 2024-04-12 DOI:10.1007/s00399-024-01014-0
Matthijs J M Cluitmans, Gernot Plank, Jordi Heijman
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Abstract

Cardiac arrhythmias remain a major cause of death and disability. Current antiarrhythmic therapies are effective to only a limited extent, likely in large part due to their mechanism-independent approach. Precision cardiology aims to deliver targeted therapy for an individual patient to maximize efficacy and minimize adverse effects. In-silico digital twins have emerged as a promising strategy to realize the vision of precision cardiology. While there is no uniform definition of a digital twin, it typically employs digital tools, including simulations of mechanistic computer models, based on patient-specific clinical data to understand arrhythmia mechanisms and/or make clinically relevant predictions. Digital twins have become part of routine clinical practice in the setting of interventional cardiology, where commercially available services use digital twins to non-invasively determine the severity of stenosis (computed tomography-based fractional flow reserve). Although routine clinical application has not been achieved for cardiac arrhythmia management, significant progress towards digital twins for cardiac electrophysiology has been made in recent years. At the same time, significant technical and clinical challenges remain. This article provides a short overview of the history of digital twins for cardiac electrophysiology, including recent applications for the prediction of sudden cardiac death risk and the tailoring of rhythm control in atrial fibrillation. The authors highlight the current challenges for routine clinical application and discuss how overcoming these challenges may allow digital twins to enable a significant precision medicine-based advancement in cardiac arrhythmia management.

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心脏电生理学数字双胞胎:技术现状与未来挑战。
心律失常仍然是导致死亡和残疾的主要原因。目前的抗心律失常疗法效果有限,这在很大程度上可能是由于其治疗方法与机制无关。精准心脏病学旨在为个体患者提供有针对性的治疗,以最大限度地提高疗效并减少不良反应。为实现精准心脏病学的愿景,硅内数字双胞胎已成为一种前景广阔的策略。虽然数字孪生没有统一的定义,但它通常采用数字工具,包括基于患者特定临床数据的机理计算机模型模拟,以了解心律失常机制和/或进行临床相关预测。在介入心脏病学领域,数字孪生已成为常规临床实践的一部分,商业化服务使用数字孪生来无创确定血管狭窄的严重程度(基于计算机断层扫描的分数血流储备)。虽然在心律失常管理方面尚未实现常规临床应用,但近年来,数字双胞胎在心脏电生理学方面取得了重大进展。与此同时,在技术和临床方面仍然存在重大挑战。本文简要概述了用于心脏电生理学的数字双胞胎的历史,包括最近在预测心脏性猝死风险和调整心房颤动节律控制方面的应用。作者强调了目前常规临床应用所面临的挑战,并讨论了如何克服这些挑战才能让数字孪生在心律失常管理方面取得基于精准医疗的重大进展。
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来源期刊
Herzschrittmachertherapie und Elektrophysiologie
Herzschrittmachertherapie und Elektrophysiologie Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.10
自引率
0.00%
发文量
76
期刊介绍: Mit wissenschaftlichen Original- und Übersichtsarbeiten, Berichten über moderne Operationstechniken und experimentelle Methoden ist die Zeitschrift Herzschrittmachertherapie + Elektrophysiologie ein Diskussionsforum für Themen wie: - Zelluläre Elektrophysiologie - Theoretische Elektrophysiologie - Klinische Elektrophysiologie - Angewandte Herzschrittmachertherapie - Bradykarde und tachykarde Herzrhythmusstörungen - Plötzlicher Herztod und Risikostratifikation - Elektrokardiographie - Elektromedizinische Technologie - Experimentelle und klinische Pharmakologie - Herzchirurgie bei Herzrhythmusstörungen Mitteilungen der Arbeitsgruppen Herzschrittmacher und Arrhythmie der Deutschen Gesellschaft für Kardiologie - Herz und Kreislaufforschung e.V. (DGK) sowie Stellungnahmen und praktische Hinweise runden das breite Spektrum dieser Zeitschrift ab. Interessensgebiete: Kardiologie, Herzschrittmachertherapie, Herzschrittmachertechnologie, klinische Elektrophysiologie
期刊最新文献
[Controversies in rhythmology]. [Atrial fibrillation in combination with severe mitral regurgitation : Which should be treated first, the atrial fibrillation or the mitral valve?] [Initial ablation of atrial fibrillation-Is pulmonary vein isolation sufficient? : Pro and contra]. [(LV)EF is a poor predictor of sudden cardiac death : Pro/Contra]. Erratum zu: Herzrhythmusstörungen bei Erwachsenen mit angeborenen Herzfehlern.
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