In a first-of-its-kind clinical trial, Johns Hopkins researchers used personalized digital twin hearts to guide treatment for life-threatening arrhythmias. The approach delivered faster, more precise procedures and a 100% success rate more than a year later.
Doctors at Johns Hopkins University have used computer-made “digital twins” of patients’ hearts to guide treatment for life-threatening abnormal heart rhythms, achieving a 100% success rate in a first clinical trial.
The approach, tested in patients with a dangerous rhythm disorder called ventricular tachycardia, led to faster, more precise procedures and no arrhythmia recurrences more than a year later. The results, published in the New England Journal of Medicine, suggest that personalized virtual hearts could transform how doctors treat some of the most serious cardiac conditions.
Ventricular tachycardia often strikes people who have already had a heart attack and have damaged heart tissue. It can cause the heart to beat so fast and chaotically that it cannot pump blood effectively, leading to fainting, cardiac arrest or death. A common treatment is catheter ablation, in which doctors thread a thin tube into the heart and burn or freeze small areas of tissue that trigger the dangerous rhythm.
But finding the right spots to treat is notoriously difficult. The damaged areas that cause the arrhythmia can be scattered and hidden, and procedures can last many hours. Even after all that, the long-term success rate of traditional ablation is only about 60%, and patients often need repeat procedures that further scar the heart.
To tackle this problem, the Johns Hopkins team turned to “digital twins” — detailed computer models of individual patients’ hearts that behave like the real organs.
Medical digital twins are built from imaging and other clinical data and are designed to mimic how an organ functions and responds to changes. In cardiology, that means simulating how electrical signals move through the heart muscle and where they get trapped or misdirected.
“For patients, digital twins can be life-changing and life-saving,” first author Jonathan Chrispin, a cardiologist who specializes in treating arrhythmias, said in a news release. “We show we can make their procedures safer, shorter and more effective by targeting only the critical portions of the heart.”
In the FDA-approved TWIN-VT trial, 10 patients who had suffered heart attacks and were living with ventricular tachycardia underwent this new, highly personalized planning process.
First, each patient received a contrast-enhanced 3D MRI scan. Researchers used those images to build a digital twin of that person’s heart, capturing its unique shape, scars and structural damage. They then ran computer simulations to see how electrical waves traveled through the virtual heart and where they became trapped in damaged tissue.
Those simulations allowed the team to predict which regions were actually driving the arrhythmia, how best to reach them with a catheter and whether the abnormal rhythm was likely to return after treatment.
“In the patient’s digital twin, we can try different scenarios for treatment before we treat the actual patient and provide the treating physician with the best, most optimal scenario, minimizing damage to the heart, and increasing the potential for a successful treatment,” added senior author Natalia Trayanova, the Murray B. Sacks Professor of Biomedical Engineering, whose lab developed the digital twin technology used in the trial. “The digital twin allows us to address all potential sources of arrythmias that may not be seen by clinical interrogation. We exhaust all possibilities.”
Once the team identified the targets in the virtual heart, they imported those locations into the navigation system used in the electrophysiology lab. Chrispin and colleagues then performed the ablation using this roadmap, focusing only on the areas flagged by the digital twin.
The results were striking. After the procedures, doctors were unable to provoke ventricular tachycardia in any of the 10 patients during testing, a standard way to check whether the arrhythmia circuits have been eliminated. Two patients had brief episodes while their hearts were healing, but more than a year later, all 10 remained free of the dangerous rhythm.
By comparison, traditional ablation for this condition succeeds in the long term in only about 60% of patients. In this small trial, the success rate was 100%.
Medication use also dropped. Eight of the 10 patients were able to stop taking anti-arrhythmia drugs entirely, and the remaining two were able to lower their doses.
“We show the technology isn’t merely feasible, it has excellent outcomes,” Trayanova added. “This demonstrates a crowning achievement in this technology that allows us to go further toward a larger clinical trial.”
Beyond the numbers, the study offers a glimpse of a future in which doctors can rehearse complex procedures on a virtual version of a patient before ever touching the real organ. That could reduce procedure times, limit unnecessary damage to healthy tissue and give patients a better chance at a durable cure.
Digital twin technology is part of a broader movement toward precision medicine, which aims to tailor care to each person’s biology rather than relying on one-size-fits-all approaches. In cardiology, that could eventually mean using virtual hearts not only to plan ablations, but also to predict who is at highest risk for dangerous rhythms, test how different drugs might work in a given patient or guide device placement.
For now, the Johns Hopkins team is focused on scaling up. They plan to test cardiac digital twins in larger groups of patients to confirm the benefits and understand which patients stand to gain the most. They are also working to streamline the technology so it can run on standard desktop computers and deliver results to clinicians within minutes, making it practical for everyday use in hospitals.
The researchers also hope to adapt the approach to other heart conditions, such as different types of arrhythmias and structural heart diseases.
If those efforts succeed, the idea of a digital twin heart could move from cutting-edge research to a standard part of care, giving doctors a powerful new tool and patients a safer path to healing.
Source: Johns Hopkins University