Abstract

Cardiac resynchronization therapy (CRT) is a common intervention for patients with dyssynchronous heart failure, yet approximately one-third of recipients fail to respond due to suboptimal lead placement. Identifying optimal pacing sites remains challenging, largely due to patient-specific anatomical variability and the limitations of current individualized planning strategies. In a step towards constructing an in-silico approach to help address this issue, we develop two geometric deep learning (DL) models, based on graph neural network (GNN) and geometry-informed neural operator (GINO), to predict cardiac activation time map in real-time for CRT planning and optimization. Both models are trained on a large synthetic dataset generated from finite-element (FE) simulations over a wide range of left ventricular (LV) geometries, pacing site configurations, and tissue conductivities. The GINO model significantly outperforms the GNN model, with lower prediction errors (1.14% vs 3.14%) and superior robustness to noise and various mesh discretization. Using the GINO model, we also develop a workflow for optimizing the pacing site in CRT from given activation time map and LV geometry. Compared to randomly selecting a pacing site, the CRT optimization workflow produces a larger reduction in maximum activation time (20% vs. 8%). In conjunction with an interactive web-based graphical user interface (GUI), the GINO model shows promising potential as a clinical decision-support tool for personalized pre-procedural CRT optimization.