Digital Twin-Guided Ablation for Ventricular Tachycardia

Russ Hobbie and I discuss the electrical behavior of the heart in Chapter 7 of Intermediate Physics for Medicine and Biology. We focus a lot on cardiac arrhythmias and devices such as pacemakers and defibrillators used to treat those arrhythmias. One researcher that Russ and I cite during this discussion is Natalia Trayanova.

This week, Trayanova is in the news because of her recent study published in the New England Journal of Medicine: “Digital Twin-Guided Ablation for Ventricular Tachycardia” (Volume 394, Pages 1345–1347, 2026). Ablation is a way of intentionally destroying a small region of tissue, usually by burning it. Often an arrhythmia can be prevented if just the right spot in the heart is ablated. The trick is finding that spot. Trayanova’s team created computer simulations that are specific for each person’s own heart: a digital twin. If someone had a heart attack that killed the tissue in a certain region of the heart, that damage is included in the twin. If a patient’s heart has grown and remodeled because it had to pump harder than normal (perhaps the heart wall thickened), those changes are included in the twin. They next run their computer model over and over, destroying different regions of tissue until they find the location that stops the arrhythmia. Then they tell the surgeon where to ablate.

This sounds great in theory, but does it work in practice? The recent New England Journal of Medicine publication reports the results of the first clinical trial.

We conducted the TWIN-VT study… a clinical study performed under a Food and Drug Administration (FDA) investigational device exemption… to prospectively test the ability of the heart digital twin to guide ischemic VT [ventricular tachycardia, a type of heart arrhythmia] ablation procedures. The FDA limited the study to one institution in the United States [Johns Hopkins University, where Trayanova works] and 10 participants.

What were the results?

In all 10 participants, no VT was inducible at the end of the procedure. No periprocedural complications occurred.

In other words, all the patients got rid of their arrhythmia and there were no complications. Wow! This is better than traditional ablation without a digital twin. Granted, the study had only ten patients, so it should be considered a preliminary result, not a definitive conclusion. But still, Wow!

This study has implications for Intermediate Physics for Medicine and Biology. Trayanova was trained in physics, and then later changed her research area to biomedical engineering and medicine. Her work suggests that basic engineering principles, computational methods, and physics training (all topics stressed in IPMB) can impact—dare I say “revolutionize”—modern medicine. As you will hear in Trayanova’s TED talk below, sometimes physics ideas are not immediately embraced by medical doctors, but the effort to introduce the rigor of physics into medicine is worth the effort. 

Well done, Natalia. 

Your Personal Digital Heart, Natalia Trayanova, TEDxJHU

https://www.youtube.com/watch?v=wSDMPxGGy3A 

Interview with Natalia Trayanova on DoctorPodcasts hosted by Robert Cykiert, M.D.

https://www.youtube.com/watch?v=STeJylvPQzk 

Digital Twins Improve Patient Outcomes

https://www.youtube.com/watch?v=uRstW1eiSrM