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. 2019 Aug 31;79(6):2033–2068. doi: 10.1007/s00285-019-01419-3

Inverse localization of earliest cardiac activation sites from activation maps based on the viscous Eikonal equation

Karl Kunisch 1, Aurel Neic 2, Gernot Plank 2, Philip Trautmann 1,
PMCID: PMC6858910  PMID: 31473798

Abstract

In this study we propose a novel method for identifying the locations of earliest activation in the human left ventricle from activation maps measured at the epicardial surface. Electrical activation is modeled based on the viscous Eikonal equation. The sites of earliest activation are identified by solving a minimization problem. Arbitrary initial locations are assumed, which are then modified based on a shape derivative based perturbation field until a minimal mismatch between the computed and the given activation maps on the epicardial surface is achieved. The proposed method is tested in two numerical benchmarks, a generic 2D unit-square benchmark, and an anatomically accurate MRI-derived 3D human left ventricle benchmark to demonstrate potential utility in a clinical context. For unperturbed input data, our localization method is able to accurately reconstruct the earliest activation sites in both benchmarks with deviations of only a fraction of the used spatial discretization size. Further, with the quality of the input data reduced by spatial undersampling and addition of noise, we demonstrate that an accurate identification of the sites of earliest activation is still feasible.

Keywords: Shape optimization, Nonlinear elliptic PDEs, Inverse problems, Electro physiology

Introduction

Computational models of cardiac function are increasingly considered as a clinical research tool with the perspective of being used, ultimately, as a diagnostic modality. Independently of which functional aspects are being considered, a key driving mechanism of cardiac electro–mechano–fluidic function is the sequence of electrical activation. Owing to its pivotal role, computer models intended for clinical applications must be parameterized in a patient-specific manner to approximate the electrical activation sequence in a given patient’s heart. Anatomical (Demoulin and Kulbertus 1972; Ono et al. 2009) as well as early experimental mapping studies (Durrer et al. 1970), using ex vivo human hearts provided evidence that electrical activation in the left ventricle (LV), i.e. the main pumping chamber that drives blood into the circulatory system, is initiated by the His–Purkinje system (Haissaguerre et al. 2016) at several specific sites of earliest activation (root points) which are located at the endocardial (inner) surface of the LV. In a first approximation it can be assumed that the healthy human LV is activated at these root points by a tri-fascicular conduction system (Rosenbaum et al. 1969) consisting of three major fascicles referred to as anterior, septal and posterior fascicle. Owing to the fast conduction properties of the Purkinje network tissue patches surrounding root points are activated fast enough so that their activation can be considered instantaneous. Size and location of these patches as well as the corresponding instants of their activation are key determinants shaping the activation sequence of the LV. Since the His–Purkinje system is highly variable in humans, there is significant interest in inverse methods for identifying these sites, ideally non-invasively.

In general, non-invasive electrocardiographic imaging attempts to reconstruct the spatio-temporal behavior of the electrical sources of the heart from electrocardiograms recorded from the body surface by solving the inverse problem of electrocardiography (Gulrajani et al. 1989). Solving this inverse problem is complicated by the non-uniqueness of the relation between myocardial sources and their signature outside the heart, recorded in the form of extracellular electrograms. The vast body of research found in the literature can be broadly categorized based on the regularization techniques used to rule out solutions that are unlikely on physiological grounds (Tikhonov and Arsenin 1977) and the model used for representing the cardiac sources, with the predominant source models being transmembrane voltage-based (He et al. 2003; Wang et al. 2010), extracellular-potential based (Rudy and Burnes 1999; Bear et al. 2018), and activation/recovery-based (van Dam et al. 2009; Erem et al. 2014; Han et al. 2015; Janssen et al. 2018). These models have their pros and cons in terms of verifiability with experimental data, the domains in which sources can be reconstructed—on epicardial and endocardial surfaces or transmurally throughout the myocardial wall—and their accuracy in pathological scenarios such as the presence of infarcts (Wang et al. 2013) or more complex non-physiological activation patterns such as arrhythmias (Rudy 2013). For a comprehensive overview of these aspects of ECG imaging we refer to the recent review of Cluitmans et al. (2018).

In this study we propose a novel method for identifying these sites of earliest activation from activation maps measured at the epicardial (outer) surface of the heart. Such maps can be obtained non-invasively from body surface potential maps within clinical routine using inverse mapping systems such as CardioInsight (Ramanathan et al. 2004). Epicardial activation maps depend not only on location and timing of initial activation sites, but also on the orthotropic conduction velocities within the LV wall. Therefore, in patient-specific applications, conduction velocity tensors have to be identified using fast forward computational models (Zettinig et al. 2014; Marchesseau et al. 2013a, b), or biophysically detailed models (Potse et al. 2014). The propagation of electrical wavefronts in the LV is modeled based on the viscous Eikonal equation which is able to represent activation sequences and takes into account the dependency of conduction velocity on wavefront curvature. Identification of sites of earliest activation is achieved by solving a minimization problem. Initially geometries are chosen which represent the activation sites. Then they are relocated based on a perturbation field until a minimal mismatch between the computed and the given activation maps at the epicardial surface is achieved. The perturbation field is designed to reduce the functional subject to minimization during the relocation process. The proposed method is tested in two numerical benchmarks, a generic 2D unit-square benchmark serving the sole purpose of theoretical analysis, and an anatomically accurate MRI-derived 3D human LV benchmark to demonstrate potential utility in a clinical context. For unperturbed input data, our localization method is able to accurately reconstruct earliest activation sites in both benchmarks with deviations of only a fraction of the used spatial discretization size. With the quality of the input data reduced by spatial undersampling and addition of noise, we demonstrate that an accurate identification is still feasible.

From a mathematical point of view the described problem can be interpreted as an inverse problem involving a non-linear elliptic PDE. On the activation sites ωi, i=1,,N an electrical depolarization wave is initiated which travels through the heart Ω=U\i=1Nωi. This is modelled by a nonlinear elliptic PDE, given by a viscous Eikonal equation, see Colli Franzone et al. (1990). The solution of the viscous Eikonal equation quantifies the arrival times of wave fronts at points in the heart Ω or on its surface ΓO. Since the wave is initiated on i=1Nωi the arrival time is zero on i=1Nωi and thus the viscous Eikonal equation has zero Dirichlet boundary conditions on i=1Nωi and Neumann boundary conditions on the rest of the boundary of Ω. Given measurements of the arrival times on the surface of the heart ΓO the positions of the activation sites ωi are searched for. This inverse problem can be formulated as a shape optimization problem, see Delfour and Zolesio (2011) or Sokołowski and Zolésio (1992), in which the positions of ωi is optimized such that the misfit between the measured data and the solution of the viscous Eikonal equation on ΓO is minimal. We assume that the shape and number of activation sites is known and stays constant during the optimization. Thus only the locations of the activation sites are changed during the optimization. For the derivation of the shape derivative of the shape functional we use a technique which does not require the shape differentiability of the geometry-to-state mapping, see Ito et al. (2008) and Laurain and Sturm (2016). In order to apply this technique we first prove the wellposedness of the state equation. It is a nonlinear elliptic PDE which can be transformed to a linear one using the Hopf–Cole transformation, see Capuzzo Dolcetta (2003). The proof of the continuous dependence of the state on the data requires non-standard techniques. Furthermore we prove the wellposedness of the linearized and adjoint state equation using the weak maximum principle. In order to compute the shape derivative the averaged adjoint technique from Laurain and Sturm (2016) is used. In this manner we arrive at domain-based representation of the shape derivative, in contrast to the more common boundary-based representation, see Sokołowski and Zolésio (1992). This simplifies the numerical implementation of the shape derivative in a finite element environment, since only domain integrals need to be calculated. For the calculation of the perturbation field which is the basis for changing the geometry of the activation sites in an iterative gradient based algorithm a linear elasticity problem is solved in which the shape derivative enters as righthand side. To give a brief account of the contents of the paper, in Sect. 2 after the statement of the model on which our approach is based, we give its mathematical analysis, involving primal, tangent, and adjoint equations, and the shape derivative. The use of this information for numerical realization is described in Sect. 3. Finally Sect. 4 contains the two benchmark examples alluded to above.

Theoretical analysis

Problem statement

Let URd, with d=2 or d=3, be a bounded domain with C2,1 boundary, representing the cardiac domain. Within U we introduce N subdomains ωi with C2,1 boundaries ωi, which represent the volumes of the earliest activation sites, also denoted as activation sources. The union of ωi is denoted by ω=i=1Nωi and its boundary by Γ=i=1Nωi. As such, Γ is the surface from which activation spreads into our computational cardiac domain Ω:=U\ω¯. We have Ω=ΓU, and thus Ω is a bounded domain with C2,1 boundary. In particular it is connected, but due to the holes it is not simply connected. Furthermore ΓΩ is closed. We set ΓN=U, and further introduce the observatory boundary ΓOΓN, which in our application is given by epicardium of the heart. We consider the following minimization problem:

minΩ,ΓJ(Ω,Γ)=12ΓO(T(x)-z(x))2dx 1

subject to the viscous Eikonal equation in the form

-εdiv(MT)+|T|M2=1inΩT=0onΓ-εMT·n_=gonΓN 2

for some non-negative function g, and with

|T(x)|M:=T(x)M(x)T(x).

The function T(x) represents the activation time, while the epicardial activation input data is denoted by z(x) which is assumed to be an element of L(ΓO). The matrix M(x) models the squared cardiac conduction velocity (see Sect. 3.5). It is assumed to be symmetric and uniformly elliptic, i.e. there exists a α>0 such that

M(x)ζ·ζα|ζ|2ζRd,xU¯.

For the rest of this work we use the notation Mα. The vector n_ denotes the outer unit normal vector on ΓN.

The use of Eikonal equations is well-established to approximate the excitation process in the myocardium. We refer, for instance, to Colli Franzone et al. (1990) where a careful singular perturbation technique analysis with respect to the thickness of the myocardial wall and the time taken by the excitation wave front to cross the heart wall is carried out on the basis of the bidomain equations to arrive at various forms of Eikonal equations (Colli Franzone et al. 1990, Section 5).

Problem (1) falls in the class of inverse shape problems. For the numerical solution of (1) we require the shape derivative of J with respect to Γ in order to use it in a gradient decent method. As prerequisite we need to prove well-posedness of the state equation (2) which arises as PDE constraint in (1), and we analyze the tangent and adjoint equations.

Well-posedness of the viscous Eikonal equation

In this section, we discuss the well-posedness of the equation

-εdiv(MT)+|T|M2=finΩT=0onΓεMT·n_=gonΓN, 3

for some functions fg specified later. Using the transformation T(x)=-εlog(w(x)+1) this problem can be transformed into

-ε2div(Mw)+fw=-finΩw=0onΓε2Mw·n_+gw=-gonΓN, 4

which is linear in the unknown w. Let us introduce the spaces

W01,p(ΩΓN):=Cc(ΩΓN)¯W1,p(Ω)=vW1,p(Ω)|v|Γ=0

for 1p< which are equipped with the norm

vW01,p(ΩΓN):=vLp(Ω).

Moreover we set V:=H01(ΩΓN):=W01,2(ΩΓN). For p>1 let p its conjugate exponent. We introduce the positive and negative part of f defined by f+:=max(0,f) and f-:=max(0,-f) as well as the embedding constant cp>0 of the embedding wL2p(Ω)cpwV. Next we require the following assumptions on the regularity of the data:

  • (Ai)

    MC0,δ(Ω¯,Rd2) with 0<δ<1, Mα/2 and MC0,δ(Ω¯,Rd2)ρM

  • (Aii)

    fLp(Ω) with f-Lp(Ω)ε2α/4cp2, p>d and fLp(Ω)ρf

  • (Aiii)

    gL(ΓN) with g0 and gL(ΓN)ρg

Lemma 1

For every (Mfg) satisfying (Ai), (Aii) and (Aiii), there exists a unique solution wV of (4). Moreover the solution satisfies wW01,p(ΩΓN) with p>2 if d=2, and with p(3,6] if d=3, and

wW01,p(ΩΓN)C

where C>0 depends continuously on ε, α, ρM, ρf and ρf.

Proof

Let τN:VL2(d-1)/(d-2)(ΓN) denote the continuous trace operator onto ΓN. Using the embedding VL2d/(d-2)(Ω) and (Aii), it is easy to see that the integral Ωfwvdx is well defined for every vV. Due to the mentioned properties of the trace operator τN and (Aiii) we can conclude that the boundary integral ΓNgwvds is well defined. Thus we can formulate the weak form of (4) as

ε2ΩMw·vdx+Ωfwvdx+ΓNgwvds=-Ωfvdx-ΓNgvds 5

for all vV. To argue existence of a solution of (5) we use the Lax–Milgram theorem. To prove the required coercivity in V we estimate for any wV using (Aii) and (Aiii)

ε2ΩMw·wdx+Ω(f+-f-)w2dx+ΓNgw2dsε2α2wV2-f-Lp(Ω)wL2p(Ω)2ε2α2-cp2f-Lp(Ω)wV2ε2α4wV2.

Thus we obtain coercivity and the existence of a unique solution w to (5). Moreover there exists a constant C>0 depending on α and ε such that

wVC(fLp(Ω)+gL(ΓN)).

Next we argue additional regularity of w. For this purpose we consider the terms involving fw and gw as known inhomogeneities with wV. We show that the functionals F1(v):=Ωfwvdx and F2(v):=ΓNgwvds are elements of (W1,p(Ω)) with p(1,2) for d=2 and p[6/5,3/2) for d=3. First we consider F1. We recall the embedding W1,p(Ω)Lq¯(Ω) with q¯=dp/(d-p)=dp/(dp-d-p) and q¯=dp/(d+p). We prove that fwLq¯(Ω). Using Hölder’s inequality with r=(d+p)/d resp. r=(d+p)/p we obtain

fwLq¯(Ω)fLp(Ω)wLd(Ω)cfLp(Ω)wV

and thus

F1(W1,p(Ω))cfLp(Ω)wV.

Next we consider F2. We recall from Adams and Fournier (2003, Theorem 5.22) that τN is continuous from W1,p(Ω) to Lq(ΓN) with q=(dp-p)/(d-p). Next we verify that gτNwLq(ΓN) with q=p(d-1)/d(p-1)=p(d-1)/d. We have

gτNwLq¯(ΓN)gL(ΓN)τNwLq¯(ΓN)cgL(ΓN)wV

since τN:VL2(d-1)/(d-2)(ΓN). Here the restriction p6 is necessary. Then assumption (Aiii) implies the assertion. Finally we get

F2(W1,p(Ω))cgL(ΓN)wV.

Moreover vΩfvdx and vΓNgτNvdx are functionals from (W1,p(Ω)). A functional F from (W1,p(Ω)) can represented in the form

F,v(W1,p(Ω)),W1,p(Ω)=Ωf1v+f2·vdx

with f1Lp(Ω) and a vector field f2Lp(Ω,Rd), see Adams and Fournier (2003, Theorem 3.8). Thus the results from Troianiello (1987, Theorem 3.16) imply that wW01,p(ΩΓN) holds and the existence of a constant C depending on ρM, ε and α such that

wW01,p(ΩΓN)C(gL(ΓN)+fLp(Ω))wV+gL(ΓN)+fLp(Ω)C(gL(ΓN)+fLp(Ω))2+gL(ΓN)+fLp(Ω).

These results are applicable since the Dirichlet part Γ of Ω is closed.

In order to proof even higher regularity of w we use the following assumptions:

  • (Bi)

    MC1,δ(Ω¯,Rd2) with Mα and MC1,δ(Ω¯,Rd2)ρM

  • (Bii)

    fC0,δ(Ω¯) with f>0 and fC0,δ(Ω¯)ρf

  • (Biii)

    gC1,δ(ΓN) with g0 and gC1,δ(ΓN)ρg

for some 0<δ<1.

Lemma 2

Let Assumptions (Bi), (Bii) and (Biii) be satisfied. Then the solution of (4) satisfies wC2,δ(Ω¯) with 0<δ<1 given according to the data. Moreover there exists a constant C>0 depending continuously on α, ε, ρM, ρf and ρg such that

wC2,δ(Ω¯)C

and -1<w(x)0 holds for all xΩ¯.

Proof

Theorem 3.28 (ii) and 3.29 (ii) from Troianiello (1987) can be applied, since (4) can be written as

-ε2i,j=1dMi,jxixjw+i=1daixiw+fw=-finΩw=0onΓi=1dbixiw+gw=-gonΓN

with ai:=-ε2div(Mi)C0,δ(Ω¯) (Mi ith column of M) and bi:=ε2(Mn)iC1,δ(ΓN) since MC1,δ(Ω¯,Rd2) and ΓN is of class C2,1. This gives us the stated regularity and the corresponding a priori estimate. Next we define w+:=max(0,w) and (w+1)-:=max(0,-(w+1)). Since (w+1)-|Γ=0 we can test (5) with v=-(w+1)- and get

-Ωf|(w+1)-|2dx=-ε2ΩMw·(w+1)-dx-ΓNg(w+1)(w+1)-dsε2ΩM(w+1)-·(w+1)-dx+ΓNg|(w+1)-|2ds0

This implies -1w in Ω¯, since f>0. Testing (5) with v=w+. We get

Ωf|w+|2dx=-Ωfw+dx-ε2ΩMw·w+dx-ΓNg(w+1)w+ds0.

This implies w0 in Ω¯. Next we introduce the variable w^=-(w+1) which satisfies the equation

-ε2div(Mw^)+w^f=0inΩw^=-1onΓε2Mw^·n_+w^g=0onΓN.

If the solution w^ were constant, it has to be equal to -1. However, in this case we have w^=0 in Ω, which is a contradiction. We define O:=maxxΩ¯w^[-1,0], see above. First we assume O=0. Then Theorem 3.27 in Troianiello (1987) is applicable which states that such a maximum cannot be achieved on ΩΓN. This is a contradiction. Thus O[-1,0) and w^[-1,0). This implies the assertion.

For the rest of this work we fix a gC1,δ(ΓN) with g0, 0<δ<1 and qC1,δ(ΓN)ρg. Let

Y=YM×YfC1,δ(Ω¯,Rd2)×C0,δ(Ω¯)

be a reflexive Banach space which embeds compactly into C0,δ(Ω¯,Rd2)×Lp(Ω) for some 0<δ<1, where the range of p is defined in Lemma 1. We define the set

BY:=(M,f)Y:(M,f)Yρ,Mα,fβ. 6

for some ρ=2max(ρM,ρf),β>0. Note that for (M,f)BY conditions (Bi), (Bii) are satisfied.

Proposition 1

There exists a constant c¯(0,1) such that

-c¯w(M,f;x)0xΩ¯

for all (M,f)BY.

Proof

We shall employ a compactness argument. For this purpose we argue that BY is compact in C0,δ(Ω¯,Rd2)×Lp(Ω). The compact embedding of Y into C0,δ(Ω¯,Rd2)×Lp(Ω) implies precompactness of BY. Moreover BY is closed in C0,δ(Ω¯,,Rd2)×Lp(Ω). Indeed, let (Mn,fn)n=1BY be a convergent sequence in C0,δ(Ω¯,,Rd2)×Lp(Ω) with the limit point (Mf). It is easy to see that Mα holds. There exists a subsequence (Mnk,fnk)k=1 such that fnk converges for almost every xΩ to f. Thus f satisfies fβ. On another subsequence of this subsequence there holds (Mnk,fnk)(M,f) in Y due to the reflexivity of Y. Since BY is convex and closed in Y, it is weakly closed in Y. Thus we have (M,f)BY which implies the closedness of BY in C0,δ(Ω¯,,Rd2)×Lp(Ω). Finally this implies that BY is a compact subset of C0,δ(Ω¯,,Rd2)×Lp(Ω).

Next we define

B=(M,f):satisfy(Ai),(Aii)and(M,f)C0,δ(Ω¯,Rd2)×Lp(Ω)K,

where K>sup(M,f)BY(M,f)C0,δ×Lp(Ω). We observe that there exists a κ(0,ε2α8cp2) such that for every (M¯,f¯)BY the set

Bκ(M¯,f¯):=(M,f):(M-M¯,f-f¯)C0,δ(Ω¯,,Rd2)×Lp(Ω)<κ

satisfies the inclusion Bκ(M¯,f¯)B. For the coordinate f this is a consequence of the estimates

f-Lp(Ω)-f+-f¯Lp(Ω)f-f¯Lp(Ω)κ,

and hence

f-Lp(Ω)2κ<ε2α4cp2.

We remark that Lemma 1 is applicable for (M,f)B and thus for elements of Bκ(M¯,f¯) with (M¯,f¯)BY. Next we choose an arbitrary (M¯,f¯)BY and (M,f)Bκ(M¯,f¯). Furthermore we introduce (δM,δf)=(M¯-M,f¯-f) and δw=w¯-w=w(M¯,f¯)-w(M,f). The solution w exists according to Lemma 1. The function δw satisfies the equation

ε2ΩM¯δw·vdx+Ωf¯δwvdx+ΓNgδwvds=ε2ΩδMw·vdx-Ωδf(w+1)vdx 7

for all vV. Next we prove that vε2ΩδMw·vdx is an element of (W1,p(Ω)). Since MC0,δ(Ω¯,Rd2) and wW01,p(ΩΓN), there holds

ε2ΩδMw·vdxε2δMC0,δ(Ω¯,,Rd2)wW01,p(ΩΓN)vW1,p(Ω).

Then similar arguments as in the proof of Lemma 1 yield a constant C>0 depending on ε, α and ρM such that

δwW01,p(ΩΓN)Cf¯Lp(Ω)+gL(ΓN)δwV+ε2δMC0,δ(Ω¯,Rd2)wW01,p(ΩΓN)+δfLp(Ω)w+1W1,p(Ω)Cf¯Lp(Ω)+gL(ΓN)ε2δMC0,δ(Ω¯,Rd2)wW01,p(ΩΓN)+δfLp(Ω)w+1W1,p(Ω)+ε2δMC0,δ(Ω¯,Rd2)wW01,p(ΩΓN)+δfLp(Ω)w+1W1,p(Ω), 8

where p is specified in Lemma 1. The expressions involving w are estimated in terms of ρg, ε, α and K. Thus there holds

δwW01,p(ΩΓN)h(δMC0,δ(Ω¯,Rd2),δfLp(Ω)), 9

where h:R2R is a continuous function with h(0,0)=0.

Now, let (M¯,f¯) be an arbitrary element in BY. By Lemma 2 there exists a constant c~=c~(M¯,f¯)(0,1) such that -c~w(M¯,f¯;x)0 for all xΩ¯. Since W01,p(ΩΓN)C(Ω¯) for p>d and due to (9) there exists a γ=γ(M¯,f¯)<κ such that

-1+c~2w(M,f;x)xΩ¯

for all (M,f)Bγ(M¯,f¯). The family {Bγ(M¯,f¯):(M¯,f¯)BY} is an open covering in C0,δ(Ω¯,Rd2)×Lp(Ω) of the compact set BY. Hence there exists a finite subcover {Bγ(M¯i,f¯i):(M¯i,f¯i)}i=1N. Then we choose

c¯:=1+max1iNc~(M¯i,f¯i)2,

to conclude the desired result.

With the help of Lemma 2 we are able to define T=-εlog(w+1) and calculate

T=-εw+1w,div(MT)=-εw+1div(Mw)+ε(w+1)2|w|M2.

Thus there holds

-εdiv(MT)+|T|M2=ε2w+1div(Mw)-ε2(w+1)2|w|M2+ε2(w+1)2|w|M2=f.

Moreover we have on the boundary

T|Γ=-εlog(1)=0,εMT·n_|ΓN=-ε2w+1Mw·n_|ΓN=g.

We are now prepared to state the existence theorem for the state equation (3).

Theorem 1

Let (M,f)BY where BY is defined in (6). Then Eq. (3) has a unique solution TC2(Ω¯) satisfying

TC2(Ω¯)CT, 10

where CT only depends on BY.

Proof

Since existence of T was argued above only the estimate has to be proven. We know T=-εlog(w+1), T=-εw+1w and

xixjT=ε(w+1)2xiwxjw-εw+1xixjw.

Thus there holds

T(x)=-εlog(w(x)+1)-εlog(-c¯+1)K1,|T(x)|=ε1(w+1)|w(x)|ε1(-c¯+1)|w(x)|K2

and

|D2T(x)|ε(-c¯+1)2|w(x)|+ε-c¯+1|D2w(x)|K3

where c¯ is the constant from Proposition 1 and Ki only depends on BY. This implies (10).

Well-posedness of the tangent and adjoint equations

Let TC2(Ω¯)V be the solution of the state equation for a (M,f)BY and T^ for (M^,f^)BY. Associated to the linearization of (2) we define the bilinear form B:V×VR by

B(v,φ):=ΩεMv·φ+M(T+T^)·vφdx

for any φ,vV. Moreover we introduce the operators A:VV and A:VV defined by

Av,φV,V=B(v,φ)=v,AφV,V

for all v,φV.

Definition 1

For FV we call vV a solution of the linearized state equation if it solves the equation Av=F or equivalently

B(v,φ)=F,φV,VφV. 11

Lemma 3

The mapping (M,f)T from BY endowed with the topology of C0,δ(Ω¯,Rd2)×L6(Ω) to W01,6(Ω) is continuous.

Proof

Let T be the solution of the state equation for M and f and T~ for M~ and f~. Let w be the solution of (4) for M, f and w~ for M~ and f~. Due to Taylor expansion of 1 / x at w~(x)+1 the partial derivative of the difference δT:=T-T~ satisfies the equation

xjδT(x)=εw~(x)+1xjw~(x)-εw(x)+1xjw(x)=εw~(x)+1-εw(x)+1xjw~(x)-εw(x)+1xjδw(x)=ε(w~(x)+1)2δw(x)-εη(x)3δw(x)2xjw~(x)-εw(x)+1xjδw(x),

where δw:=w-w~ and η(x) lies between w(x)+1 and w~(x)+1. Due to Proposition 1 we have

|xjδT(x)|ε|δw(x)|1(-c¯+1)2+c¯(-c¯+1)3|xjw~(x)|+ε-c¯+1|xjδw(x)|.

Now estimate (9) for δw in the proof of Proposition 1 with p=6 and Lemma 2 imply the assertion.

Proposition 2

Let r(2,) and FW1,r(Ω). Then the linearized state equation has a unique solution vW01,r(ΩΓN) and there exists a constant C>0 such that for all (M,f)BY

vW01,r(ΩΓN)C(FW1,r(Ω)).

Proof

First we observe the following estimate

ΩM(T+T^)·vvdxαε2vV2+12αεMC(Ω¯,Rd2)2(T+T^)C(Ω¯)2vL2(Ω)2.

Then we have

B(v,v)+λvL2(Ω)2αε2vV2+λ-12αεMC(Ω¯,Rd2)2(T+T^)C(Ω¯)2vL2(Ω)2αε2vV2+(λ-12αεc2ρM2CT2)vL2(Ω)2

for some c>0. Now for the choice λ12αεc2ρM2CT2 the form B is coercive relative to L2(Ω). It can be easily checked that B is bounded. The bilinear form B is also defined on H1(Ω)×V and there holds that B(1,v)=0 for any vV. Then Troianiello (1987, Theorem 2.4) implies that A satisfies the weak maximum principle. Thus the homogenous equation Av=0 has the unique solution 0. Then Troianiello (1987, Theorem 2.2) yields the existence of a unique solution vV of Av=F for every FV which satisfied the inequality

vVA-1FV.

Next we discuss the dependence of A-1 on M and T. First we remark that T depends on M and f. Thus we prove that the mapping (M,f)A is continuous from BY endowed with the topology of C0,δ(Ω¯,Rd2)×L6(Ω) to L(V,V). Let (Mf) and (M~,f~) be elements of BY and A resp. A~ the corresponding operators. Then we estimate

(A-A~)v,φV,V=Ω(M-M~)v·φdx+Ω(M-M~)(T+T^)·vφdx+2ΩM~(T-T~)·vφdxcM-M~C(Ω¯,Rd2)(1+(T+T^)L6(Ω))+M~C(Ω¯,Rd2)(T-T~)L6(Ω)vVφV

Thus we have

A-A~cM-M~C(Ω¯,Rd2)+(T-T~)L6(Ω),

since (T+T^)L6(Ω)c~CT for some c~>0 and M~L(Ω)c^ρM for some c^>0. Then Lemma 3 implies the continuity of (M,f)A from BYC0,δ(Ω¯,Rd2)×L6(Ω) to L(V,V). Thus the mapping (M,f)A-1 is continuous from BY endowed with the topology of C0,δ(Ω¯,Rd2)×L6(Ω) to L(V,V). Since BY is compact in C0,δ(Ω¯,Rd2)×L6(Ω) for some 0<δ<1 there exists a constant C>0 only depending on BY such that A-1C.

Finally we apply Troianiello (1987, Theorem 3.16, (iv)) which implies that vW01,r(ΩΓN) and

vW01,r(ΩΓN)C^(FW1,r(Ω)+vV),

where C^ depends on ε, α, ρM and CT.

Definition 2

For FV we call φV a solution of the adjoint state equation if it satisfies the equation Aφ=F or equivalently

B(v,φ)=F,vV,VvV. 12

Theorem 2

Let r(2,) and FW1,r(Ω). Then Eq. (12) has a unique solution φW01,r(ΩΓN). Moreover there exists a constant C>0 such that for all (M,f)BY

φW01,r(ΩΓN)C(FW1,r(Ω)). 13

Proof

From the proof of Proposition 2 it follows that A:VV is continuous and bijective. Thus A:VV is also continuous and bijective. In particular we have (A)-1=(A-1). So the equation Aφ=F has a unique solution φV for every FV and

φV(A-1)FV=A-1FVCFV

for some constant C>0 which is uniform in (M,f)BY. Then we apply Troianiello (1987, Theorem 3.16, (iv)) which implies that φW01,r(ΩΓN) and

φW01,r(ΩΓN)C^(FW1,r(Ω)+φV),

where C^ depends on ε, α, ρM and CT.

Let us note that the strong form corresponding to (12) is formally given by

-εdiv(Mφ)-divM(T+T^)φ=F|ΩinΩφ=0onΓεMφ·n_+2φMT·n_=F|ΓNonΓN. 14

Shape derivative of J

We follow the notation and strategy in Ito et al. (2008) and Laurain and Sturm (2016). For a field hCc3(U,Rd) and t>0 we define the mappings Ft:URd by Ft=idRd+th. Then we introduce the perturbed domains Ωt=Ft(Ω) and the perturbed manifolds Γt=Ft(Γ). Since h vanishes near ΓN there exists a τ>0 such that ΩtU for all t[0,τ]. Moreover, let gC2(ΓN) with g0 as well as gC1,δ(ΓN)ρg for some 0<δ<1 and MC2(U¯,Rd2) with Mα be given. The perturbed state equation has the form

ΩtεMTt·v+(MTt·Tt-1)vdx-ΓNgvds=0vH01(ΩtΓN),

for t[0,τ]. We introduce

A(t)=ξ(t)B(t)M(t)B(t),whereB(t)=DFt-,ξ(t)=det(DFt),M(t)=MFt,

and define the non-linear form e:[0,τ]×W01,4(ΩΓN)×VR as

e(t,Tt,v)=ΩεA(t)Tt·v+(A(t)Tt·Tt-ξ(t))vdx-ΓNgvds.

After transformation to the reference domain Ω, the perturbed state equation can be cast as

e(t,Tt,v)=0vV,t[0,τ], 15

with the relation between Tt and Tt given by Tt=TtFt. Next we discuss the differentiability of A(t) and ξ(t). We shall use the notation

Mvh=k=1dDMkvkh,

where Mk stands for the kth column of M.

Lemma 4

There holds

limt01tξ(t)-1-tξ(0)C(Ω¯)=0,limt01tA(t)-M-tA(0)C(Ω¯,Rd2)=0,

where ξ(0)=div(h), and

A(0)v=div(h)Mv-DhMv+Mvh-MDhv,forvRd. 16

Proof

Let xΩ¯ be arbitrary. The function ξ(t;x) has the form

ξ(t;x)=1+tr(Dh(x))t-det(Dh(x))t2,d=2 17

and

ξ(t;x)=1+tr(Dh(x))t-(det(Dh1(x))+det(Dh2(x))+det(Dh3(x)))t2+det(Dh(x))t3,d=3

where Dhi are the principal minors of Dh. Thus we have

1t|ξ(t;x)-1-tdiv(h(x))|3DhC(Ω¯,Rd2)2t+DhC(Ω¯,Rd2)3t2.

Thus the first assertion is proven. Let us turn to the differentiability of tA(t). Since MC2(U¯,Rd2) and U¯ is compact it follows that tM(x+th(x)) is differentiable from [0,) to C(U¯,Rd2) at t=0+. The derivative can be conveniently computed by its action on any vRd

tM(t)v|t=0=k=1dtMk(t)t|t=0vk=k=1dDMkhvk=k=1dDMkvkh.

Now let xΩ¯ be arbitrary and let t be so small such that tDhC(Ω¯,Rd2)<1. Then there holds

1tB(t;x)-Id+tDh(x)=1tk=0(-t)k(Dh(x))k-Id+tDh(x)k=2tk-1DhC(Ω¯,Rd2)k

A similar proof shows

limt01tB(t)-Id+tDhC(Ω¯,Rd2)=0.

Utilizing the product rule on A(t)=ξ(t)B(t)M(t)B(t) leads us to (16).

The formulas for ξ and A also provide the following result.

Lemma 5

The mappings tA(t) from [0,τ] to C1(Ω¯,Rd2) and tξ(t) from [0,τ] to C1(Ω¯) are continuous in 0.

Let Y=YM×Yf=W2,s(Ω,Rd2)×W1,s(Ω)C1,δ(Ω¯,Rd2)×C0,δ(Ω¯) with s>d and δ=1-d/s. Then Y is compactly embedded in C0,δ(Ω¯,Rd2)×Lp(Ω) for any 0<δ<1 and p>d. Due to the last lemma there exists a τ such that A(t)α/2 and ξ(t)1/2 for all t[0,τ]. Furthermore there exists a ρ>0 such that (A(t),ξ(t))Yρ for all t[0,τ] holds. Then we define the set

BY={(M,f)Y:(M,f)Yρ,Mα/2,f1/2}

and get

{(A(t),ξ(t)):t[0,τ]}BY.

Thus we have:

Proposition 3

The perturbed state equation has a unique solution TtC2(Ω¯)VW01,4(ΩΓN).

Proof

This follows directly from Theorem 1.

The perturbed cost functional can be written as

J(Ωt,Γt)=j(t,Tt)=12ΓO(Tt-z)2dx 18

subject to e(t,Tt,v)=0 for all vV. Next we characterize the shape derivative

dJ(Ω,Γ)h=limt0J(Ωt,Γt)-J(Ω,Γ)t

at Ω in direction h. For this purpose we define the Lagrange functional

L(t,Tt,p)=j(t,Tt)+e(t,Tt,p)

for some pV and t[0,τ]. We shall follow Laurain and Sturm (2016) to show that

dJ(Ω,Γ)h=ddtL(t,Tt,φt)|t=0, 19

where Tt solves (15) and φt solves the averaged adjoint equation

01dTL(t,sTt+(1-s)T0,φt)δTds=0δTW01,4(ΩΓN). 20

At first we characterize the right hand side of (19). First we observe that

dTL(t,Tt,φt)δT=ΓO(Tt-z)δTds+ΩεA(t)δT·φt+2A(t)Tt·δTφtdx.

Since Tt and T0 appear linearly in (20), the averaged adjoint equation amounts to

ΓO([Tt]-z)δTds+ΩεA(t)δT·φt+2A(t)[Tt]·δTφtdx=0δTW01,4(ΩΓN), 21

where [Tt]=1/2(Tt+T0)C2(Ω¯).

Proposition 4

The averaged adjoint equation has a unique solution φtW01,r(ΩΓN) with r(d,).

Proof

We need to prove that vΓO([Tt]-z)τNvds is an element of W1,r(Ω). We know that τN is continuous from W1,r(Ω) to Lq(ΓO) with q=(dr-r)/(d-r). Thus we need to show that [Tt]|ΓO-zLq(ΓO) with q=r(d-1)/d(r-1)=r(d-1)/d. This is true since TC2(Ω¯) and zL(ΓO).

In order to justify (19) we need the following technical lemma.

Lemma 6

Further let Tt and φt be the solutions of (15) and of (20) for t(0,τ]. Then we have

TtT0inW01,6(ΩΓN)fort0,φtφ0inVfort0.

Proof

The first result follows from Lemmas 3 and 5. Let φt be the solution of the averaged adjoint state equation (21) for A(t), [Tt]=1/2(Tt+T0) and z. We define δφ=φt-φ0 which solves

ΩεA(t)v·δφ+A(t)(Tt+T0)vδφdx=Ωε(M-A(t))v·φ0+(2(M-A(t))T0-A(t)δT)·vφ0dx+12ΓOδTvds

for all vV. Next we show that vΩ(M-A(t))T0vφ0dx is an element of V. This follows from the fact that φ0W01,r(ΩΓN)C(Ω¯) and T0C1(Ω¯,Rd). Moreover the functional vΩA(t)δTvφ0dx is also a functional in V, since δTW01,6(ΩΓN). According to the proof of Theorem 2 there holds

δφVCεA(t)-MC(Ω¯,Rd2)φ0W01,r(ΩΓN)+φ0W01,r(ΩΓN)A(t)-MC(Ω¯,Rd2)T0C2(Ω¯)+A(t)C(Ω¯,Rd2)φ0W01,r(ΩΓN)δTW01,6(ΩΓN)+δTW01,6(ΩΓN),

with C>0 independent of t. Moreover due to Theorem 2 there exists a constant c1>0 depending only on BY such that φ0W01,r(ΩΓN)<c1 holds. Furthermore there holds T0C2(Ω¯)CT and A(t)L(Ω)c2ρM with c2 independent of t. This finishes the proof using Lemma 5.

We introduce the outer product vw=vw for v,wRd and the inner product G:N=trace(GN) for G,NRd×d. Now we have all necessary ingredients to prove the main result of this subsection.

Theorem 3

The shape derivative dJ(Ω,Γ) of J defined in (18) satisfies

DJ(Ω,Γ)h=ddtL(t,Tt,φt)|t=0=ΩS1:Dh+S0·hdx 22

for any hCc3(U,Rd), where Si, i=0,1 have the form

S1=IdRd(εMT·φ+(|T|M2-1)φ)-ε(TMφ+φMT)-2TMTφ, 23
S0=εMTφ+MTTφ. 24

Proof

We apply Theorem 2.1 from Laurain and Sturm (2016). Thus we need to prove that

limt01t(L(t,T0,φt)-L(0,T0,φt))=tL(0,T0,φ0).

The functional J only depends on t through Tt. Thus we have

1t(L(t,T0,φt)-L(0,T0,φt))-tL(0,T0,φ0)=1t(e(t,T0,φt)-e(0,T0,φt))-te(0,T0,φ0)=1tΩε(A(t)-M-tA(0))T0·φt+tA(0)T0·(φt-φ0)+(A(t)-M-tA(0))T0·T0φt+tA(0)T0·T0(φt-φ0)-(ξ(t)-1-tξ(0))φt-tξ(0)(φt-φ0)dx

Thus we can estimate in the following way:

1t(L(t,T0,φt)-L(0,T0,φt))-tL(0,T0,φ0)εtA(t)-M-tA(0)C(Ω¯,Rd2)T0VφtV+εA(0)C(Ω¯,Rd2)T0Vφt-φ0V+c1tA(t)-M-tA(0)C(Ω¯,Rd2)T0C(Ω¯,Rd)2φtV+A(0)C(Ω¯,Rd2)T0C(Ω¯,Rd)2φt-φ0V+c~1tξ(t)-1-tξ(0)C(Ω¯)φtV+ξ(0)C(Ω¯)φt-φ0V.

Then Lemmas 6 and 4 imply the assertion. In order to calculate

ddtL(t,Tt,φt)|t=0

we recall Lemma 4 and in particular (16). We obtain

ddtL(t,Tt,φt)|t=0=ΩεA(0)T0·φ0+(A(0)T0·T0-div(h))φ0dx

with

A(0)v=div(h)Mv-DhMv+Mvh-MDhv,forvRd.

Next we give a more usable formula for the shape derivative. For convenience we suppress the superscript for T0 and φ0 in the following. In particular we have

εA(0)T·φ=(εMT·φ)IdRd:Dh-(εφMT):Dh+(εMTφ)·h-(εTMφ):Dh,A(0)T·Tφ=φ|T|M2IdRd:Dh-(TMTφ):Dh+(MTTφ)·h-(TMTφ):Dh,div(h)φ=φIdRd:Dh.

Practical implementation

In this section we describe the practical implementation of an algorithm utilizing the shape derivative DJ for the reconstruction of the locations of the activation sites. We assume that these sites have the form ωi=Bri(xi) with radii ri and midpoints xi, i=1,,N. For these activation sites we reconstruct the midpoints xi.

The state and adjoint state equations

Since the state equation is of nonlinear elliptic type which in practically relevant situations is posed on domains with challenging geometry, we propose to solve it using linear finite elements and a Newton method. For convenience we recall the state equation as

e(T,v)=ΩεMT·v+(|T|M2-1)vdx-ΓNg2vds=0vW01,4(ΩΓN). 25

In order to set up a Newton method we need to calculate the derivative of e, in particular we have

dTe(T,φ)v=ΩεMv·φ+2MT·vφdx. 26

The Newton equation is well posed, see Proposition 2. For a given solution T of the state equation, the adjoint state equation in the variable φV has the form

dTe(T,φ)v=ΩεMv·φ+2MT·vφdx+ΓN(T-z)vdx=0,vV. 27

This is a linear elliptic equation of convection-diffusion type, which we again solve by linear finite elements.

Domain perturbation

While the overall source localization algorithm requires only a displacement of the current source locations, we still calculate a vector field for the perturbation over the whole domain Ω¯. This vector field h is chosen as the solution of the vector valued elliptic equation

UDh:Dv+h·vdx=-ΩS1:Dv+S0·vdx,vH01(U,Rd), 28

where Si, i=0,1 are defined in (24) resp. (23). We remark that h is defined on U and not only on Ω. The last equation is solved using linear finite elements. We also note that

DJ(Ω,Γ)h=-UDh:Dh+h·hdx0,

and thus h is a decent direction for J. Since we are only interested in the shift of the midpoints xi of the balls ωi, we average h over ωi, i=i,,N, in order to get a shift of the midpoints.

Finite element solver implementation

The domain Ω is discretized using tetrahedral elements and linear Ansatz functions {ψi}. As such, there are three linear systems to be solved at least once in each iteration of the source localization loop:

  1. The linear equation in the Newton iteration KNT_=f_N, with
    KNi,j=ΩεMψi·ψj+2(MT·ψi)ψjdxf_Ni=-ΩεMT·ψi+(MT·T-1)ψidx.
  2. The adjoint state equation KAφ_=f_A, with
    KAi,j=ΩεMψj·ψi+2(MT·ψj)ψidxf_Ai=ΓN(T-z)ψidx.
  3. The domain perturbation equation KSh_=f_S, with
    KSi,j=I3×3Ωδxψiδxψj+δyψiδyψj+δzψiδzψj+ψiψjdxf_Si,1=ΩS11,1δxψi+S11,2δyψi+S11,3δzψi+S01ψidxf_Si,2=ΩS12,1δxψi+S12,2δyψi+S12,3δzψi+S02ψidxf_Si,3=ΩS13,1δxψi+S13,2δyψi+S13,3δzψi+S03ψidx,
    where S0 and S1 are defined according to respectively (24) and (23).

The linear systems are assembled and manipulated using the PETSc (Balay et al. 2017) framework. All three linear system are solved using the Boomer (Henson and Yang 2002). Algebraic Multigrid preconditioner in combination with the GMRES solver provided by PETSc. The linear solver in the Newton method is configured with a relative residual error tolerance of 10-4, while all other solvers use an absolute residual error tolerance of 10-8. The detailed solver settings are listed in the appendix.

Source localization

The goal of the source localization algorithm is to identify the midpoints xi, i=1,,N of the sources {ωi} that minimize our functional J. Our shape calculus based on shape derivatives does not allow for splitting or the creation of activation sites. For this purpose one has to resort to topological derivatives.graphic file with name 285_2019_1419_Figa_HTML.jpg

We propose the approach depicted in Algorithm 1. Required inputs are some starting locations {xi0}, a user-specified, mesh dependent step-length (usually 1-3 mesh edge-lengths), a step-length scaling parameter θ and a backtracking scale α. The symbol · denotes the Euclidean norm. The algorithm starts by initializing T0 and J0. Then, while the tolerance condition on Jk is not met, in each iteration of the while-loop it computes solutions to (27) and (28), updates the source midpoint positions and finally computes a new state solution to (25). If necessary backtracking is employed, and the next iteration begins.

For complex geometries, the step-length needs to be chosen small enough in order to prevent the sources from being moved out of Ω. Note, that only realizes an upper bound on λihik, but this quantity is not bounded from below. Choosing θ>1 improves convergence speed, as the λi are scaled up to counteract the reduction of hk. In the case of overshooting, oscillations are reduced by backtracking.

According to the problem statement, the sources {ωi} are not part of the computational domain Ω. In each iteration k, all points of Ω¯ are moved based on the perturbation field hk, in particular the current source surface Γk=i=1Nωik is moved. In practice it is easier to solve also the state and adjoint equations on U=Ωω¯ with ω=i=1Nωik and apply the Dirichlet boundary values on whole ω¯. Then we only translate the logical representation of ω and thus the discretization of U is not perturbed. This prevents the need for re-meshing and implicitly enables the merging of any ωi without requiring special algorithmic treatment. Once λihik is smaller than the average FE mesh edge-length, local refinement would become necessary. This however, is not within the scope of this work.

Model parameters

The tensor parameter M contains the squared cardiac conduction velocity. In the depth of the human LV wall, conduction velocity is orthotropic due to numerous factors, with the most important ones being the geometry of myocytes and the non-uniform distribution of conduction-mediating proteins and sodium channels. The fastest propagation velocity vf is observed along the prevailing long axis orientation of myocytes, often referred to as “fiber orientation” f_. Excitation spread within a sheet and along direction s_, which is orthogonal to f_, occurs at a lower conduction velocity vs, and even slower in a sheet normal direction n_=f_×s_, at a velocity vn. Both orthotropic velocities as well as the principal axes {f_,s_,n_} vary in space. In general, vf>vs>vn holds where the ratios are assumed as vf:vs:vn4:2:1 based on experimental studies (Caldwell et al. 2009). As such, M is defined as

M:=vf2f_f_+vs2s_s_+vn2n_n_. 29

The 2D benchmark in Sect. 4.2 will feature constant fiber-and sheet-directions f_=(1,0) and s_=(0,1) with varying (vf,vs), while the 3D human LV benchmark in Sect. 4.3 will have constant velocities vf=0.6m/s, vs=0.4m/s, vn=0.2m/s and heterogeneous vectors {f_,s_,n_}, computed by a rule-based method (Bayer et al. 2012). Further, in the human LV benchmark M(x) is an element-wise function. This makes the computation of S0 impractical. While it would be possible to change the representation of M, this has not been pursued, since the terms involving S0 have only a small impact on the shape derivative, see the comparisons in Sect. 4.2.

The parameter ε is calibrated by comparing the macroscopic velocity of propagating wavefronts generated by the viscous Eikonal model with physiological measurements such as the observed temporal delay between endocardial activation and epicardial breakthrough. Depending on a given trajectory relative to the used fiber field, macroscopic velocities fall into the range of local conduction velocities encoded in M, which themselves are based on experimental measurements (Caldwell et al. 2009).

Evaluation benchmarks

Two numerical benchmarks, a 2D wedge benchmark and a 3D LV benchmark, will be used to evaluate the proposed algorithm’s ability to identify activation sources based on input boundary data.

Evaluation criteria

In both benchmarks we measure both the convergence of the current source locations {xik} to the exact source locations {xi}, and the reduction of the functional J defined in (1). Thus the following evaluation criteria are used:

  • the distances to reference locations dik:=xi-xik

  • the relative reduction Jk/J0 with Jk:=12ΓO(Tk-z)2dx.

2D benchmark

In this benchmark, the computational domain U is given by the unit-square (0,1)×(0,1). We consider two activation sites ωi=B0.1(xi) whose midpoints are given by x1=(0.5,0.3) and x2=(0.25,0.7). Thus we have Ω=U\i=12ωi. The observed data are given on the boundary ΓN of U. The domain U is discretized by 66,049 vertices and 131,072 triangles, which yields a discretization size of 4·10-3. Moreover we set g=0, f=1, ε=0.1 and

M=sin(πx)+1.100sin(πy)+1.1.

In this example we consider the noise free case. Thus the observed data z is generated by solving the state equation for T and restricting T to ΓN. In Fig. 1 we observe that the distances between the exact midpoints xi and xik reach values below 10-3, more precisely d1=1.7·10-4 and d2=2.6·10-4, after 100 iterations. These distances correspond approximately to the mesh size. On the right of this figure we can note that Jk/J0 attains a value of about 10-7. Figure 2 shows the trajectories of the points xik as the iteration proceeds. We can see that the midpoints xik do not move in straight lines. We expect that this is caused by interaction between the two activation sites, and the influence of M. Nevertheless the exact midpoints xi are reached with high precision. In Fig. 3 the perturbation field hk and the adjoint state φk are displayed for k=0,10,20. The dominant directions of the perturbation field point from regions of Ω where φk is negative to regions of Ω where φk attains high positive values. Moreover we see that the trajectories of the points xik (Fig. 2) correlate to the main directions of the perturbation field hk.

Fig. 1.

Fig. 1

The evaluation criteria for the 2D benchmark. Left: distance to reference location dik:=xik-xi,i=1,2 over the iteration k. Right: relative functional reduction Jk/J0 over the iteration k

Fig. 2.

Fig. 2

Left: trajectory of the points x1k and x2k during optimization. Right: magnitude of Sij over iterations k

Fig. 3.

Fig. 3

Perturbation field hk (arrows) and adjoint state variable φk (background color; blue-negative and red-positive) for k=0,10,20. The vectors are scaled for better visibility. The color of the vectors correlates with their length. (blue-short and red-long) (color figure online)

In order to study the influence of the different parts of DJk we introduce the quantities:

S11=εΩ(IdRdMTk·φk):Dhkdx,S12=Ω(|Tk|M2-1)φkIdRd):Dhkdx,S13=εΩ(TkMφk+φkMTk):Dhkdx,S14=Ω(2TkMTkφk):Dhkdx,S01=εΩ(MTkφk)·hkdxandS02=Ω(MTkTkφk)·hkdx.

We clearly see in Fig. 2 that S13 and S14 are the dominating summands in |DJkhk|. Thus it is justified to omit the terms S01 and S02 in the following benchmark. We also carried out tests with different choices for the conductivity tensor M and found nearly identical behavior provided that M is given by (29) with orthonormal vectors f_ and s_. If the choice for M violates the orthonormality condition for f_ and s_, then the numerical results may depend on the directions determined by the spatial relation between the exact activation sites and the initial guess, and the directions given by f_ and s_.

3D LV benchmark

The 3D LV benchmark serves to gauge the potential of the proposed method in an envisioned clinical application which is geared towards localizing earliest activation sites from epicardial activation maps. In line with early experimental mapping studies (Durrer et al. 1970) on ex vivo human hearts we assume that there are three discrete sites of earliest activation located at the endocardial surface of the LV. In anatomical terms, these sites are located higher towards the base of the LV on the anterior paraseptal wall, a central area at the septal endocardium, and a posterior paraseptal area. Therefore the conduction system activating the LV is referred to as “trifascicular” with the three fascicles being referred to as anterior fascicle xaf, posterior fascicle xpf and septal fascicle xsf. Each of these fascicles can be considered as a patch of tissue composed of a tight network of Purkinje fibers which are electrically coupled to the LV myocardium through so-called Purkinje-Ventricular junctions (PVJs). Owing to the fast conduction properties of the Purkinje fibers in these patches a large number of PVJs are located which activate one after the other with very short delays. Thus, these patches appear to activate simultaneously and are considered a fascicle and not a large set of individual PVJs. Further, due the short delays and the close spatial vicinity, it is still highly challenging today, even with invasive mapping devices recording signals with electrodes located in the immediate vicinity of PVJs, to identify individual PVJs. As such we do not expect that the identification of individual PVJs using data recorded at the epicardial surface is feasible.

While the presence of three fascicles is widely accepted and there general location is assumed to be known, the inter-individual variability and their exact location, size and relative timing is significant. Based on these considerations we assume the activation map (either measured or precomputed) on the epicardial surface as given input data for the localization of the three LV fascicles which we deem a plausible and sufficiently accurate general representation of the actual activation sources. Moreover, we simplify by assuming size and timing of individual fascicles as given and focus only on the identification of their location.

The discretized model of a human LV forming the computational domain Ω consists of 47,938 vertices and 245,611 tetrahedra, with an average discretization size of 1.5mm. The observable surface ΓO is formed by the epicardial surface of the LV. We refer to Fig. 4. The source surface is Γ=i=13ωi with ωi:=Br=3mm(xi),i=1,2,3. Further, based on numerical tests with varying activation sequences we chose ε=80ms to obtain appropriate macroscopic conduction velocities which fall into the range of local conduction velocities encoded in M (see Sect. 3.5).

Fig. 4.

Fig. 4

a The LV geometry forming Ω, b the surface ΓO, c the fiber directions f_

Motivated by real-world applications, we want zL2(ΓO) to correspond to some error-prone data defined on a lower spatial resolution than the computational resolution of ΓO. To accommodate for this, the data z are generated as follows:

  1. A reference activation time Tr, using the source locations
    x1=(60.3,27.6,-20.9),x2=(42.7,-12.8,-2.6)andx3=(26.9,19.6,-39.1)
    is computed.
  2. Tr is sub-sampled at a set of 106 uniformly spaced sample points {si}i=1106ΓO yielding ti:=Tr(si).

  3. A zero-average uniform noise is added: titi+ξi1/|Ω|ΩTr(x)dx,i=1,,106 with ξi[-ξ/2,ξ/2].

  4. The data z is interpolated from the perturbed samples {ti} using distance-weighted interpolation.

We compare the following cases for different data selections:

  • (RI) Using the reference data as input: z:=Tr|ΓO.

  • (II) Using only interpolated input: z is generated as described above with ξ=0.

  • (PI) Using perturbed and interpolated input: z is generated as described above with ξ=0.3.

Starting at the initial locations

x10=(71.1,11.3,-18.4),x20=(44.7,-23,-25.2)andx30=(42.3,9.1,-46.8),

the source localization Algorithm 1 is applied. In order to find the best achievable results, the algorithm is configured to only stop if J cannot be further reduced. All three cases executed in approximately 250 seconds on 10 cores of a workstation PC with two Intel Xeon E5645 (2.40 GHz) CPUs.

Figure 5 shows the two evaluation criteria—the summed distances to reference location and the relative reduction of J—over the iteration count. For (RI), the algorithm terminates after 29 iterations with a relative error minimum of 3·10-4. The highest final distance to reference location is d1=1mm, which is well below the average FE edge-length of 1.5mm. The discrete representation of the reconstructed activation sites closely match the desired reference sites.

Fig. 5.

Fig. 5

The evaluation criteria for the cases (RI), (II) and (PI) of the LV benchmark. Left: i=13dik over the iteration k. Right: Relative functional reduction Jk/J0 over the iteration k

In the (II) case, the algorithm stops after 29 iterations. The minimal relative error is 5.4·10-3. The highest final distance is d1=4.3mm, which is significantly larger than in the (RI) case. This indicates that the low-resolution sampling of Tr|ΓO lowers the quality of our reconstruction. Also, the interpolation induces noise which impairs the reconstruction quality.

For (PI), the algorithm terminates after 30 iterations with relative error 1.6·10-2. The di are similar to the (II) case, although slightly higher, with the highest final distance d1=4.4mm. This further hints that the low-resolution sampling has a much greater effect on the source locations than the error due to noise.

For all three cases, the final displacements xik-xik-1 are smaller than 0.2 mm, and therefore only a fraction of the mesh edge-length of 1.5 mm. As such, some mesh manipulation (e.g. mesh refinement, mesh deformation) would be necessary in order to apply the source displacement on the state and adjoint state problems. Since the mesh is not adjusted in the presented paper, this leads to a stagnation of the algorithm.

Figure 6 visualizes the source localization process by displaying the trajectories of xik and the adjoint solution φk during the source localization process. By comparing figure parts A and B, we observe that the motion induced by the field h is oriented from negative to positive regions of φk, similar to the 2D benchmark in Sect. 4.2. Further, we see the diminishing absolute values of φk over the iteration count. The final locations in Fig. 6a show, that even the worst localization (PI) still offers a good approximation of the general source location, well inside the uncertainty bounds of clinical parameters. Moreover, we carried out numerical tests with varying anisotropy ratios, see Fig. 7. In the LV benchmark, the convergence trajectory of one source varied significantly between the three choices of M. Numerical tests with significantly higher anisotropy ratios indicate, that a higher FE mesh resolution is required, particularly in the case of large displacements orthogonal to f_.

Fig. 6.

Fig. 6

a The trajectories traveled by xik for the (RI) and (PI) cases. The (RI) trajectory is colored in green, while the one of the (PI) case is colored in red. The mesh vertices inside ball ωi, used for the reference solution Tr, are displayed in red, while those inside the initial search ball ωi0 are displayed in blue. b The adjoint solution φk for the (RI) case, for the iterations k=0,10,20,28, respectively from left to right (color figure online)

Fig. 7.

Fig. 7

The source trajectories in the (RI) case for three different choices of M. Green: vf=0.6,vs=0.4,vn=0.2. Blue: vf=0.5,vs=0.5,vn=0.5. Red: vf=0.8,vs=0.4,vn=0.2 The mesh vertices inside ball ωi, used for the reference solution Tr, are displayed in red, while those inside the initial search ball ωi0 are displayed in blue (color figure online)

Discussion

This study presented analysis and implementation of an algorithm for identifying sites of earliest activation in the LV from epicardial activation maps. The algorithm is posed as an optimization problem, where initial activation sites are chosen first to be then iteratively perturbed in order to minimize the mismatch between computed activation times and the activation maps given at the epicardial surface. We demonstrated well-posedness of all sub-problems, namely the viscous Eikonal equation, the tangent and adjoint equations and the perturbed state equation and characterized the shape derivative.

The theoretical results were verified by solving two benchmark problems, a 2D unit-square benchmark and a 3D human LV benchmark. For unperturbed input data, the localization method was able to accurately reconstruct the sites of initial activation. The largest deviations observed were 2.6·10-4 and 1 mm, respectively, for the 2D and 3D benchmark. This was significantly smaller than the respective spatial discretization sizes of 4·10-3 and 1.5 mm used in 2D and 3D benchmark, respectively. To probe the robustness of the method, the 3D benchmark was repeated using input data of reduced quality, that is, epicardial activation were spatially under-sampled and noise was added. These benchmark results showed, that the identification of earliest activation sites was still feasible, yielding a sufficiently accurate approximation of the general locations, comparable or better than the accuracy achieved with clinically used invasive endocardial mapping systems (Gepstein et al. 1997).

Several topics suggest themselves as possible extensions of the present work. The shape gradient is already set up to allow for a more realistic representation of the activations sites than those considered in the numerical realizations of these first benchmarks. Also, it can be of interest to incorporate different activation times by introducing inhomogeneous Dirichlet boundary conditions with unknown forcing terms. To allow for additional accuracy of the reconstruction of the evolution of the activation regions local grid refinement can be considered in future algorithmic efforts. Further it can be an interesting task to carry out the asymptotic analysis for ε0.

Limitations

While the benchmarks in this study demonstrate that the identification of sites of earliest endocardial activation from epicardial activation maps is, in principle, feasible with the proposed method, with regard to practical applications a number of restrictions apply. Out method makes various tacit assumptions which may not always hold in practice. Fiber arrangements are assumed to be known, following largely the patterns observed experimentally in the healthy LV (Streeter et al. 1969). With current technology fiber arrangements cannot be measured in vivo with sufficient spatial resolution,but suitable technologies under development (Scott et al. 2018) promise to lift this restriction in the future. Further, conduction velocities along the principal tensor axes were also assumed homogeneously throughout the LV, as velocities cannot be determined accurately in vivo, the chosen values were based on experimental observations (Caldwell et al. 2009). These values and their ratios may deviate from the experimentally estimation of vf:vs:vn=3:2:1, and they may not be constant throughout the myocardium. Identifying the velocity tensor fields is therefore an additional complexity which is a related research topic (Marchesseau et al. 2013a) that has not been addressed in this study. A further limitation is the assumption that three sites of earliest endocardial activation exist. While this is physiologically motivated based on the notion that three main fascicles initiate activation in the healthy human LV endocardium (Durrer et al. 1970), this may not always be the case, particularly not under pathological conditions such as a left bundle branch block where the electrical activation of the LV may follow a markedly different pattern.

Acknowledgements

: Open access funding provided by University of Graz. The authors gratefully acknowledge many useful discussions with E. Karabelas and K. Sturm.

Appendix

PETSc solver options

The following solver configuration parameters were passed at run-time to PETSc: graphic file with name 285_2019_1419_Figb_HTML.jpg

Units

The results of the LV benchmark use the following units:

Variable Unit
T,φ ms
h mm
M mm2/ms2
ε ms

Footnotes

Karl Kunisch was supported in part by the ERC advanced Grant 668998 (OCLOC) under the EU H2020 research program. Aurel Neic and Gernot Plank were supported in part by the Grant SFB MOBIS (FWF F3210-N18) and the BioTechMed Projekt “ILearnHeart”.

Publisher's Note

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Contributor Information

Karl Kunisch, Email: karl.kunisch@uni-graz.at.

Aurel Neic, Email: aurel.neic@medunigraz.at.

Gernot Plank, Email: gernot.plank@medunigraz.at.

Philip Trautmann, Email: philip.trautmann@uni-graz.at.

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