Deep Learning-based Prediction of Atrial Local Fibrosis from In Silico Intracavitary Electrograms

Santiago Moreno Pineda1, Giada Sira Romitti2, Duna De Luis Moura3, Marí­a Termenón Rivas2, Alejandro Liberos4, Miguel Rodrigo1
1Universitat de València, 2CoMMLab, Universitat de València, 3CoMMLab, Universidad de Valencia, 4Universitat de València


Abstract

Atrial fibrillation (AF) is the most common arrhythmia, and detecting its fibrotic substrate is crucial for patient prognosis and optimal targeted therapies. Currently, non-invasive assessment relies heavily on late gad-olinium enhancement (LGE-MRI), a modality limited by reproducibility and clinical accessibility. Detailed 3D anatomical simulations with fi-brotic infiltration provide a robust computational alternative. By offering an exact ground-truth, they enable precise fibrosis prediction directly from clinically routine intracavitary electrograms (EGMs). Using 5 anatomically realistic anatomies with different degrees of fi-brosis infiltration, we simulated AF patterns and generated EGMs on a virtual endocardial shell (1 mm offset, N= 163,412 EGMs). Ground-truth fibrosis was defined for each EGM as the amount of fibrosis within a radius of 3mm. We have developed a preliminary deep learning method to predict presence/absence of local fibrosis (>5%) from temporally win-dowed (200 ms) unipolar EGMs: a 1D Convolutional Neural Network with 2 convolutional blocks, optimized to detect high-frequency frag-mentations and signal amplitude variance. Evaluated on the test cohort (32,002 EGMs, unseen virtual patient), the model achieved a Balanced Accuracy score of 0.73 and an AUROC of 0.81. This approach has the potential to predict high-resolution substrate mapping from clinical recordings, helping the personalization of digital twins for targeted ablation therapies.