GEASI: Geodesic-based Earliest Activation Sites Identification in cardiac models.

The personalization of cardiac models is the cornerstone of patient-specific modeling. Ideally, non-invasive or minimally-invasive clinical data, such as the standard ECG or intracardiac contact recordings, could provide an insight on model parameters. Parameter selection of such models is however a challenging and potentially time-consuming task. In this work, we estimate the earliest activation sites governing the cardiac electrical activation. Specifically, we introduce GEASI (Geodesic-based Earliest Activation Sites Identification) as a novel approach to simultaneously identify their locations and times. To this end, we start from the anisotropic eikonal equation modeling cardiac electrical activation and exploit its Hamilton-Jacobi formulation to minimize a given objective functional, which in the case of GEASI is the quadratic mismatch to given activation measurements. This versatile approach can be extended for computing topological gradients to estimate the number of sites, or fitting a given ECG. We conducted various experiments in 2D and 3D for in-silico models and an in-vivo intracardiac recording collected from a patient undergoing cardiac resynchronization therapy. The results demonstrate the clinical applicability of GEASI for potential future personalized models and clinical intervention.