Characterising cardiac tissue properties with graph neural networks

Characterising electrophysiological properties of cardiac tissue efficiently and accurately from spatially sparse intracardiac measurements is clinically important for localising ablation targets and improving arrhythmia treatment. We developed a graph neural network-based framework trained on synthetic electrogram signals on 2D flat surfaces to identify areas of interest in the context of cardiac ablation for premature ventricular complexes (PVCs). Our method achieved an average precision of 0.96, 0.97, and 0.95 for the detection of single-patch fibrosis, rapid depolarisation and high excitability, respectively. The trained model can then be applied to 2D curved surfaces with few-shot fine-tuning, demonstrating its generalisation capability. Future work will develop this framework further for clinical use in PVC ablation.

Latent PDE mapping for efficient physics-informed learning across geometries with limited data

In this study, we introduce latent PDE mapping, a broadly applicable physics-informed learning technique designed to enable efficient geometric generalization with sparse training data. Latent PDE mapping pulls back geometry-specific PDE residuals and boundary conditions to a predefined latent geometry via the deformation gradient, thereby enabling the automated calculation of geometry-consistent shape gradients that are missing in conventional physics-informed machine learning formulations. We demonstrate the utility of latent PDE mapping in solving the anisotropic Aliev-Panfilov PDE of cardiac electrophysiology using both physics-informed neural networks and physics-informed deep operator networks. The Aliev-Panfilov PDE serves as a challenging exemplar: a nonlinear, time-dependent PDE benchmark with sharp gradients that are expensive to capture using traditional numerical solvers. To represent the limited data regime, we train the networks using just fifteen geometric samples drawn from parameterized distributions in two and three spatial dimensions. While modest improvements appear for geometries parameterized by affine and shear deformations, latent PDE mapping demonstrates significant benefits on select geometric families, achieving a factor ~4-6 reduction in mean relative L2 error. Furthermore, our results show that the computational cost of applying latent PDE mapping was modest during network training, and negligible at inference. Taken together, our study highlights how latent PDE mapping facilitates the creation of generalizable physics-informed machine learning models from limited sets of training geometries.

Learning Cardiac Electrophysiology Digital Twins Through Agentic Discovery of Hybrid Structure

Building personalized cardiac electrophysiology (EP) digital twins requires identifying the appropriate model structure for each patient, not merely fitting parameters. Traditional methods rely on experts to manually prescribe hybrid physics-neural architectures, which requires deep domain expertise and does not transfer across patients. Recent works have applied large language models (LLMs) to generate or act as hybrid models. However, despite their promising generalization capacity, these LLM-based methods lack the structural priors needed for stable cardiac simulations. Hence, we propose LEADS, a framework that formulates cardiac EP domain knowledge as a structured action space and utilizes an LLM agent to discover hybrid models. The agent follows an iterative reasoning-and-action loop to select, combine, and refine hybrid models, whilst gradient descent handles parameter fitting. The proposed LEADS designs every candidate model towards physically grounded, interpretable, and numerically stable, while allowing open-ended architectural discovery. We validate LEADS on synthetic data with three ground-truth reaction models and on real cardiac EP data, demonstrating that it outperforms both human-designed hybrid models and other LLM-based hybrid modeling.

HAPI-EP: Towards Hybrid, Adaptive, and Predictive Digital Twins of Cardiac Electrophysiology

A digital twin (DT) of a patient-specific heart offers significant potential in personalized medicine. However, its rapid and dynamic adaptation to an individual's live data and its predictive capability after adaptation remains central challenges. We examine this challenge from its two building blocks: DT formulation where mechanistic and data-driven models show competing merits and limitations, and DT optimization strategies that are largely driven by a reconstruction objective leading to un-identifiable models. We address both bottlenecks via HAPI -- an AI framework for building hybrid, adaptive, and predictive DTs with three key enablers. First, HAPI constructs a physics-integrated gray-box model in which an interpretable mechanistic backbone is augmented by a neural component that models its residual to the observed data. Second, rather than attempting to pre-encode all possible variations in a static hybrid model, HAPI enables rapid on-the-fly adaptation of the hybrid model to few-shot live data, achieved by feedforward meta-learners realizing amortized inference of both mechanistic and neural parameters of the hybrid model trained with predictive objectives. Finally, we show that this adaptivity corresponds to the construction of a conditional generative model (i.e., the hybrid DT) that endows it with theoretical identifiability and thus strong performance in predictive scenarios. We demonstrate the proof-of-concept of HAPI in cardiac electrophysiology using a hybrid monodomain model with mechanistic reaction kinetics and neural graph diffusion. Across synthetic and real-data studies, we show that HAPI's mechanistic-neural hybridization and predictive adaptation are critical for obtaining identifiable DTs with strong predictive and out-of-distribution capabilities.