To fix a patient’s irregular heartbeat, doctors first tested its digital ‘twin’

WASHINGTON (AP) — Scientists have created virtual replicas of patients’ diseased hearts so precise that blocking a dangerous irregular heart rhythm in these digital “twins” showed doctors how to better treat the diseased heart.

One of the first clinical trials of these personalized models suggests they could improve care for ventricular tachycardia, a notoriously difficult-to-treat arrhythmia that is a leading cause of sudden cardiac arrest, responsible for about 300,000 deaths annually in the United States.

The study, carried out by researchers at Johns Hopkins University, was a small first step. The Food and Drug Administration has authorized digital twin technology to guide treatment in just 10 patients, and much larger studies will be needed.

But the findings reported Wednesday in the New England Journal of Medicine come as doctors increasingly explore how a technology long used in aerospace and other industries could also be harnessed for better health.

Dr. Jeffrey Goldberger, a cardiologist at the University of Miami who was not involved in the study, experimented with more rudimentary iterations 15 years ago and praised the new findings. “It’s what we imagined,” he said.

Doctors have long used 3D models, both physical and computer-generated, to simulate diseases and practice techniques. But Natalia Trayanova, a biomedical engineer at Hopkins, said real digital twins predict how a real organ may respond to different treatments. His lab is pioneering colorful interactive models developed with advanced MRI and other data from each patient.

“We treat the twin before we treat the patient,” Trayanova said. “Did it work? And if it worked, are there new things coming up” that will require more or different care?

The heart’s electrical system powers our heartbeat. Ventricular tachycardia is a super-fast heartbeat triggered when an electrical wave short-circuits the organ’s lower chambers, the ventricles, and stops them from pumping blood to the body.

“You see this heart that is trembling,” Trayanova said.

Medications can help, but the main treatment is ablation, when doctors insert catheters into the heart to burn away faulty tissue. But it’s a bit of trial and error, as patients spend hours under anesthesia while doctors figure out where to aim. Repeat ablations are common and many patients have an implanted defibrillator as a backup.

Enter the digital twins of Trayanova’s patient ventricles. Colors swirl on a computer screen – blue, green, yellow and orange – showing how the heart’s electrical wave travels through healthy areas of the chamber before getting stuck on damaged tissue. It is trapped in a circular motion that she compares to the whirlwind of a hurricane.

“This allows me to recreate how the patient’s organ functions and then predict what the best way to ablate is,” she said.

The technology locates a dysfunctional region where the electrical wave strikes repeatedly. Virtual ablation will show if this resolves the problem or if another arrhythmia forms that will also require zapping. “Then we push it again,” she explained.

Trayanova’s team created personalized ablation targets for each of the 10 study participants. The cardiologists transferred them to a mapping system that they use as a guide and went after just those targets instead of chasing their own.

More than a year later, eight patients experienced no arrhythmia while two experienced only one brief episode during their recovery – better than the treatment’s typical 60% success rate, said Dr. Jonathan Chrispin, a Hopkins cardiologist and lead author of the study. All but two also stopped their antiarrhythmic treatment.

More importantly, cardiologists can burn less tissue by targeting “specifically areas that we think are critically important,” Chrispin said. “We could potentially make these procedures shorter, safer and more efficient. »

The Hopkins team hopes to study the digital twin approach as part of a larger study with other hospitals and has launched a trial using it to treat a more common type of irregular heartbeat called atrial fibrillation. Other researchers are studying digital twins for cancer treatment.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.