Solving the Inverse Problem of Electrocardiography for Cardiac Digital Twins: A Survey

TL;DR

This survey reviews computational methods for solving the ECG inverse problem crucial for developing personalized cardiac digital twins, highlighting recent advances, challenges, and future directions in the field.

Contribution

It provides a comprehensive classification and analysis of deterministic and probabilistic approaches, including deep learning techniques, for ECG inverse problem solving.

Findings

Deep learning enhances ECG inverse inference accuracy.

Physics-informed models improve solution robustness.

Challenges include capturing dynamic electrophysiology and quantifying uncertainty.

Abstract

Cardiac digital twins (CDTs) are personalized virtual representations used to understand complex cardiac mechanisms. A critical component of CDT development is solving the ECG inverse problem, which enables the reconstruction of cardiac sources and the estimation of patient-specific electrophysiology (EP) parameters from surface ECG data. Despite challenges from complex cardiac anatomy, noisy ECG data, and the ill-posed nature of the inverse problem, recent advances in computational methods have greatly improved the accuracy and efficiency of ECG inverse inference, strengthening the fidelity of CDTs. This paper aims to provide a comprehensive review of the methods of solving ECG inverse problem, the validation strategies, the clinical applications, and future perspectives. For the methodologies, we broadly classify state-of-the-art approaches into two categories: deterministic and probabilistic methods, including both conventional and deep learning-based techniques. Integrating physics laws with deep learning models holds promise, but challenges such as capturing dynamic electrophysiology accurately, accessing accurate domain knowledge, and quantifying prediction uncertainty persist. Integrating models into clinical workflows while ensuring interpretability and usability for healthcare professionals is essential. Overcoming these challenges will drive further research in CDTs.