Physiology-Aware Graph Attention for Early Ventricular Reentry Prediction

Characterising electrophysiological properties of cardiac tissue efficiently and accurately from spatially sparse intracardiac measurements is clinically important for localising ablation targets and improving arrhythmia treatment. We developed a graph neural network-based framework trained on synthetic electrogram signals on 2D flat surfaces to identify areas of interest in the context of cardiac ablation for premature ventricular complexes (PVCs). Our method achieved an average precision of 0.96, 0.97, and 0.95 for the detection of single-patch fibrosis, rapid depolarisation and high excitability, respectively. The trained model can then be applied to 2D curved surfaces with few-shot fine-tuning, demonstrating its generalisation capability. Future work will develop this framework further for clinical use in PVC ablation.

False ventricular tachycardia (VT) alarms are a leading contributor to alarm fatigue in intensive care units. We propose a deep learning framework combining a 1D SE-ResNet with ICU-realistic data augmentations and a physics-informed auxiliary reconstruction task based on the three-element Windkessel hemodynamic model, implemented as a differentiable forward simulation. By requiring the network's latent representation to produce physiologically plausible arterial pressure waveforms, artifact-driven ECG patterns are penalized while true VT remains coherent across modalities. Evaluated on the VTaC benchmark under a strict real-time protocol (10-second pre-alarm window), our method achieves a 5-point Challenge Score improvement over prior state-of-the-art. Ablation studies confirm that the physics-informed objective is the primary performance driver, providing gains in accuracy, 2x label efficiency, and more localized and clinically meaningful ECG segments.

Accurate localization of myocardial infarction is essential for risk stratification. While LGE-MRI remains the gold standard, it is resource-intensive. Integrating cine MRI with ECG enables a more detailed representation of infarct properties. Existing inverse MI inference methods overlook realistic scar morphology and cardiac repolarization, reducing sensitivity to subtle ECG variations and interpretability of infarct-induced electrophysiological changes. In this paper, we propose a novel framework for noninvasive MI localization using cardiac digital twins. To bridge the domain gap between simulation and reality, we introduce an anatomy-aware stochastic infarct synthesis strategy to synthesize realistic, irregular scars with border zones, mimicking ischemic transmural progression. We then construct a virtual cohort to simulate QRS-T waveforms, capturing both depolarization and repolarization dynamics. Furthermore, we design a Physiology and Anatomy Aware Network (PAA-Net) that jointly encodes 3D myocardial geometry and multi-lead ECGs to infer infarct areas with varying localizations, sizes, spatial extents, and transmuralities. Experimental results demonstrate that our framework significantly outperforms existing methods in inverse inference, achieving Dice scores of 0.7391 and 0.5503 for scar and border zone segmentation, respectively, while further enhancing the interpretability of the ECG-infarct relationship. Our code will be released upon acceptance.