Ground-breaking computer models that simulate the workings of individual patients' hearts could boost treatment of a common cardiac condition that affects a million people in the UK and countless more worldwide.
With funding from the Engineering and Physical Sciences Research Council (EPSRC) and in collaboration with St Thomas' Hospital, a team at King's College London has taken the first steps in developing models designed to optimise a procedure that corrects atrial fibrillation, a condition which causes abnormal heart rhythms.
The new personalised computer models aim to increase the effectiveness of this procedure (which is known as 'catheter ablation') by making it possible to explore, in advance, different strategies for its use geared to the specific needs of individual patients. They could potentially save the NHS over £20million a year by reducing procedure times and cutting atrial fibrillation recurrence rates.
Atrial fibrillation reduces blood supply, leading to dizziness, breathlessness and fatigue, and increases the risk of a stroke. Every year, around 10,000 people in the UK have a catheter inserted in order to treat the condition using radiofrequency energy. But the procedure is not always effective, there is a small risk of it causing a stroke or death, and the condition often recurs.
Developed using skills in computational modelling, software development and image processing, and based on detailed data about the patient's heart obtained through medical imaging, the models depict tissue condition and blood flow, and enable simulation of around 10 cardiac cycles lasting a few seconds in total.
Dr Adelaide de Vecchi of King's College London, who has led the project, says: The really important thing is that these new personalised models show the heart working as a whole 'system'. They allow different catheter ablation strategies to be assessed for each specific patient - for example, with regard to the precise area of the heart to target - and therefore enable the very best option to be pinpointed, maximising the prospect of improving the patient's quality of life.
The models have been tested in collaboration with Dr David Nordsletten, Dr Oleg Aslanidi and Dr Des Dillon-Murphy from King's, using clinical data from patients under the care of Professor Mark O'Neill at St Thomas'. The aim is now to enhance and extend the models in terms of the number of cardiac cycles they can depict and apply them to larger cohorts of patients. Once this is achieved, it is anticipated that full clinical trials will be undertaken.
Dr de Vecchi says: Subject to further development, we believe our models have the potential to enter routine clinical use within a decade, improving treatment of a condition that is especially common among older people. The models are very much in step with the drive towards personalised medicine, better cardiac care and improved management of our ageing population.
Estimated NHS cost savings are based on around 16,000 catheter ablation procedures being performed in the UK per year at an average cost of £5500 (2016 figures), amounting to a total cost of around £88million per year. Cutting procedural times and recurrence rates by 25 per cent as a result of using the new models would therefore lead to an annual saving of over £20million. This would be even higher in the US and EU, where costs are considerably higher.
Engineering and Physical Sciences Research Council (EPSRC) is part of UK Research and Innovation, a non-departmental public body funded by a grant-in-aid from the UK government. EPSRC is the main funding body for engineering and physical sciences research in the UK. By investing in research and postgraduate training, we are building the knowledge and skills base needed to address the scientific and technological challenges facing the nation. Our portfolio covers a vast range of fields from healthcare technologies to structural engineering, manufacturing to mathematics, advanced materials to chemistry. The research we fund has impact across all sectors. It provides a platform for future UK prosperity by contributing to a healthy, connected, resilient, productive nation.
King's College London is one of the UK's top ten universities (QS World University Rankings 2018/19) and the fourth-oldest university in England. Located in the heart of London, it has over 31,000 students (including over 12,800 postgraduates) from some 150 countries. Fields in which King's has a distinguished reputation include medicine, nursing and psychiatry, and the university has influenced many of the advances that shape modern life.