BOATMAP: Bayesian Optimization Active Targeting for Monomorphic Arrhythmia Pace-mapping.

Recent advances in machine learning and deep learning have presented new opportunities for learning to localize the origin of ventricular activation from 12-lead electrocardiograms (ECGs), an important step in guiding ablation therapies for ventricular tachycardia. Passively learning from population data is faced with challenges due to significant variations among subjects, and building a patient-specific model raises the open question of where to select pace-mapping data for training. This work introduces BOATMAP, a novel active learning approach designed to provide clinicians with interpretable guidance that progressively assists in locating the origin of ventricular activation from 12-lead ECGs. BOATMAP inverts the input-output relationship in traditional machine learning solutions to this problem and learns the similarity between a target ECG and a paced ECG as a function of the pacing site coordinates. Using Gaussian processes (GP) as a surrogate model, BOATMAP iteratively refines the estimated similarity landscape while providing suggestions to clinicians regarding the next optimal pacing site. Furthermore, it can incorporate constraints to avoid suggesting pacing in non-viable regions such as the core of the myocardial scar. Tested in a realistic simulation environment in various heart geometries and tissue properties, BOATMAP demonstrated the ability to accurately localize the origin of activation, achieving an average localization accuracy of 3.9±3.6mm with only 8.0±4.0 pacing sites. BOATMAP offers real-time interpretable guidance for accurate localization and enhancing clinical decision-making.