Patent Publication Number: US-2023146716-A1

Title: Digital twin of atria for atrial fibrillation patients

Description:
INCORPORATION BY REFERENCE 
     This application claims priority to U.S. Provisional Application No. 63/255,614, which was filed on Oct. 14, 2021, and is incorporated herein by reference in its entirety. 
    
    
     FIELD OF INVENTION 
     The present invention is related to signal processing. More particularly, the present invention relates to generating a digital twin of atria for atrial fibrillation (aFib) patients. 
     BACKGROUND 
     Cardiac arrhythmia, such as aFib, occurs when regions of cardiac tissue do not follow a synchronous beating cycle associated with normally conductive tissue. Generally, cardiac arrhythmia can be treated by medication, ablation or other means of tissue destruction. Yet, with respect to aFib in its advanced stages, knowing optimal locations for ablation becomes quite complicated. For instance, because aFib can vary from one patient to another and because atrial tissue can include scars and/or triggers, optimal ablation locations may need to be determined on a case by case basis. 
     Currently, ablation procedures construct and utilize digital simulations of a heart to assist with determining ablation locations. These digital simulations are based on standard anatomical information and assume a standard electrical conduction. Accordingly, it has been found that these simulations are not accurate enough and do not foster effective guidance. Thus, there is a need for improved ablation location determining techniques. 
     SUMMARY 
     According to an exemplary embodiment, an ablation procedure guidance method is provided herein. The ablation procedure guidance method is implemented by a generation engine executing on at least one processor. The ablation procedure guidance method includes receiving, by the generation engine, one or more inputs including one or more images and conduction velocity vector estimations. The ablation procedure guidance method also includes generating, by the generation engine, a digital twin of an anatomical structure utilizing the one or more images and the conduction velocity vector estimations. The ablation procedure guidance method also includes presenting, via a user interface of the generation engine, the digital twin to provide precision ablation guidance of the anatomical structure and provide electrophysiology information of the anatomical structure. 
     According to one or more embodiments, the above ablation procedure guidance method can be implemented as a system, an apparatus, and/or a computer program product. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       A more detailed understanding may be had from the following description, given by way of example in conjunction with the accompanying drawings, wherein like reference numerals in the figures indicate like elements, and wherein: 
         FIG.  1    illustrates a diagram of an example system in which one or more features of the disclosure subject matter can be implemented according to one or more embodiments; 
         FIG.  2    illustrates a block diagram of an example system for generating a digital twin of atria for aFib patients according to one or more embodiments; 
         FIG.  3    illustrates a method according to one or more embodiments; 
         FIG.  4    illustrates a graphical depiction of an artificial intelligence system according to one or more embodiments; 
         FIG.  5    illustrates an example of a neural network and a block diagram of a method performed in the neural network according to one or more embodiments; 
         FIG.  6    illustrates a method according to one or more embodiments; 
         FIG.  7    illustrates an interface according to one or more embodiments; 
         FIG.  8    illustrates an interface according to one or more embodiments; 
         FIG.  9    illustrates an interface according to one or more embodiments; 
         FIG.  10    illustrates an interface according to one or more embodiments; 
         FIG.  11    illustrates an interface according to one or more embodiments; 
         FIG.  12    illustrates graphs according to one or more embodiments; 
         FIG.  13    illustrates an interface according to one or more embodiments; 
         FIG.  14    illustrates a graph according to one or more embodiments; 
         FIG.  15    illustrates interfaces according to one or more embodiments; and 
         FIG.  16    illustrates a method according to one or more embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     Disclosed herein is a signal processing system, apparatus, and method. More particularly, disclosed herein are signal processing operations that generate a digital twin of atria for atrial fibrillation (aFib) patients. The signal processing systems, apparatus, and method can incorporate a machine learning (ML) and/or an artificial intelligence (Al) to generate and analyze the digital twin, as well as data associated therewith, to provide improved ablation location determining techniques. 
     According to one or more embodiments, a generation engine can generally correspond to the signal processing systems, apparatus, and method and include one or more ML/AI algorithms to generate and analyze the digital twin. In this regard, the generation engine can include a processor executable code or software that is necessarily rooted in process operations by, and in processing hardware of, medical device equipment. For ease of explanation, the generation engine is described herein with respect to mapping a heart (such as an atria thereof). However, any anatomical structure, body part, organ, or portion thereof can be a target for mapping by the generation engine described herein. 
     In general, the generation engine generates/creates the digital twin of the atria to serve as a guiding tool for ablations of aFib patients. Particularly, the digital twin is more robust than current digital simulations, which do not have personalized electrical activity of the heart, i.e., the digital simulations assume a standard electrical conduction and assume that arrythmias repeat themselves, which is not the case in aFib. In this regard, for example, the generation engine measures and utilizes electrical activity of the heart (e.g., while accounting for arrhythmia triggers, as well as information regarding atrial wall substances) for an aFib patient to generate and create the digital twin. By way of further example, the generation engine utilizes conduction velocity (CV) vectors (e.g., a direct heart measurement) as input to generate and create the digital twin. The CV vectors can be based on real-time data, as described herein. The CV vectors are based on the local signal progress; therefore, the generation engine can utilize far field reduction algorithms to remove a far field (i.e., signal that is based on the ventricle activation) before calculating the CV vectors. Additionally, during an ablation procedure, the generation engine can continuous update the digital twin, as well as suggest an optimal ablation and/or additional procedures based on the digital twin. 
     As a result of the operations of the generation engine, the digital twin is very accurate compared to current digital simulations. Thus, one or more advantages, technical effects, and/or benefits of the generation engine can include providing cardiac physicians and medical personnel with effective guidance during ablation procedures using the digital twin. In turn, the generation engine particularly utilizes and transforms medical device equipment to enable/implement signal processing operations that are otherwise not currently available or currently performed by cardiac physicians and medical personnel. 
       FIG.  1    is a diagram of an example system (e.g., medical device equipment and/or catheter-based electrophysiology mapping and ablation), shown as a system  10 , in which one or more features of the subject matter herein can be implemented according to one or more embodiments. All or part of the system  10  can be used to collect information (e.g., biometric data and/or a training dataset) and/or used to implement a ML/AI algorithm and far field reduction algorithms (e.g., of a generation engine  101 ) as described herein. The system  10 , as illustrated, includes a recorder  11 , a heart  12 , a catheter  14 , a model or anatomical map  20 , an electrogram  21 , a spline  22 , a patient  23 , a physician  24  (or a medical professional or clinician), a location pad  25 , an electrode  26 , a display device  27 , a distal tip  28 , a sensor  29 , a coil  32 , a patient interface unit (PIU)  30 , electrode skin patches  38 , an ablation energy generator  50 , and a workstation  55  (including at least one processor  61  and at least one memory  62 , storing a generation engine  101  therein). Note that each element and/or item of the system  10  is representative of one or more of that element and/or that item. The example of the system  10  shown in  FIG.  1    can be modified to implement the embodiments disclosed herein. The disclosed embodiments can similarly be applied using other system components and settings. Additionally, the system  10  can include additional components, such as elements for sensing electrical activity, wired or wireless connectors, processing and display devices, or the like. 
     The system  10  includes multiple catheters  14 , which are percutaneously inserted by the physician  24  through the patient’s  23  vascular system into a chamber or vascular structure of the heart  12 . Typically, a delivery sheath catheter (which is an example of the catheter  14 ) is inserted into the left or right atrium near a desired location in the heart  12 . Thereafter, a plurality of catheters  14  can be inserted into the delivery sheath catheter so as to arrive at the desired location. The plurality of catheters  14  may include catheters dedicated for sensing Intracardiac Electrogram (IEGM) signals, catheters dedicated for ablating and/or catheters dedicated for both sensing and ablating. The example catheter  14  that is configured for sensing IEGM is illustrated herein. The physician  24  brings the distal tip  28  of the catheter  14  into contact with the heart wall for sensing a target site in the heart  12 . For ablation, the physician  24  would similarly bring a distal end of an ablation catheter to a target site for ablating. 
     The catheter  14  is an exemplary catheter that includes one and preferably multiple electrodes  26  optionally distributed over a plurality of splines  22  at the distal tip  28  and configured to sense the IEGM signals. The catheter  14  may additionally include the sensor  29  embedded in or near the distal tip  28  for tracking position and orientation of the distal tip  28 . Optionally and preferably, position sensor  29  is a magnetic based position sensor including three magnetic coils for sensing three-dimensional (3D) position and orientation. 
     The sensor  29  (e.g., a position or a magnetic based position sensor) may be operated together with the location pad  25  including a plurality of magnetic coils  32  configured to generate magnetic fields in a predefined working volume. Real time position of the distal tip  28  of the catheter  14  may be tracked based on magnetic fields generated with the location pad  25  and sensed by the sensor  29 . Details of the magnetic based position sensing technology are described in U.S. Pat. Nos. 5,5391,199; 5,443,489; 5,558,091; 6,172,499; 6,239,724; 6,332,089; 6,484,118; 6,618,612; 6,690,963; 6,788,967; 6,892,091. 
     The system  10  includes one or more electrode patches  38  positioned for skin contact on the patient  23  to establish location reference for the location pad  25  as well as impedance-based tracking of the electrodes  26 . For impedance-based tracking, electrical current is directed toward the electrodes  26  and sensed at the patches  38  (e.g., electrode skin patches) so that the location of each electrode can be triangulated via the patches  38 . Details of the impedance-based location tracking technology are described in U.S. Pat. Nos. 7,536,218; 7,756,576; 7,848,787; 7,869,865; and 8,456,182, which are incorporated herein by reference. 
     The recorder  11  displays the electrograms  21  captured with the electrodes 18 (e.g., body surface electrocardiogram (ECG) electrodes) and IEGM captured with the electrodes  26  of the catheter  14 . The recorder  11  may include pacing capability for pacing the heart rhythm and/or may be electrically connected to a standalone pacer. 
     The system  10  may include the ablation energy generator  50  that is adapted to conduct ablative energy to the one or more of electrodes  26  at the distal tip  28  of the catheter  14  configured for ablating. Energy produced by the ablation energy generator  50  may include, but is not limited to, radiofrequency (RF) energy or pulsed-field ablation (PFA) energy, including monopolar or bipolar high-voltage DC pulses as may be used to effect irreversible electroporation (IRE), or combinations thereof. 
     The PIU  30  is an interface configured to establish electrical communication between catheters, electrophysiological equipment, power supply and the workstation  55  for controlling operation of the system  10 . Electrophysiological equipment of the system  10  may include for example, multiple catheters  14 , the location pad  25 , the body surface ECG electrodes 18, the electrode patches  38 , the ablation energy generator  50 , and the recorder  11 . Optionally and preferably, the PIU  30  additionally includes processing capability for implementing real-time computations of location of the catheters and for performing ECG calculations. 
     The workstation  55  includes the memory  62 , the processor unit  61  with the memory  62  or storage with appropriate operating software loaded therein, and user interface capability, as further described herein. The workstation  55  may provide multiple functions, optionally including (1) modeling the endocardial anatomy in three-dimensions (3D) and rendering the model or anatomical map  20  for display on the display device  27 , (2) displaying on the display device  27  activation sequences (or other data) compiled from recorded electrograms  21  in representative visual indicia or imagery superimposed on the rendered anatomical map  20 , (3) displaying real-time location and orientation of multiple catheters within the heart chamber, and (5) displaying on the display device  27  sites of interest such as places where ablation energy has been applied. One commercial product embodying elements of the system  10  is available as the CARTO ® 3 System, available from Biosense Webster, Inc., 31A Technology Drive, Irvine, CA 92618. 
     The system  10  can be utilized to detect, diagnose, and/or treat cardiac conditions (e.g., using the generation engine  101 ). Cardiac conditions, such as cardiac arrhythmias, persist as common and dangerous medical ailments, especially in the aging population. For instance, the system  10  can be part of a surgical system (e.g., CARTO® system sold by Biosense Webster) that is configured to obtain biometric data (e.g., anatomical and electrical measurements of a patient’s organ, such as the heart  12  and as described herein) and perform a cardiac ablation procedure. More particularly, treatments for cardiac conditions such as cardiac arrhythmia often require obtaining a detailed mapping of cardiac tissue, chambers, veins, arteries and/or electrical pathways. For example, a prerequisite for performing a catheter ablation (as described herein) successfully is that the cause of the cardiac arrhythmia is accurately located in a chamber of the heart  12 . Such locating may be done via an electrophysiological investigation during which electrical potentials are detected spatially resolved with a mapping catheter (e.g., the catheter  14 ) introduced into the chamber of the heart  12 . This electrophysiological investigation, the so-called electro-anatomical mapping, thus provides 3D mapping data which can be displayed on the display device  27 . In many cases, the mapping function and a treatment function (e.g., ablation) are provided by a single catheter or group of catheters such that the mapping catheter also operates as a treatment (e.g., ablation) catheter at the same time. 
     In patients (e.g., the patient  23 ) with normal sinus rhythm (NSR), the heart (e.g., the heart  12 ), which includes atrial, ventricular, and excitatory conduction tissue, is electrically excited to beat in a synchronous, patterned fashion. Note that this electrical excitement can be detected as intracardiac electrocardiogram (IC ECG) data or the like. 
     According to one or more embodiment, in patients (e.g., the patient  23 ) with a cardiac arrhythmia (e.g., atrial fibrillation or aFib), abnormal regions of cardiac tissue do not follow a synchronous beating cycle associated with normally conductive tissue, which is in contrast to patients with NSR. Instead, the abnormal regions of cardiac tissue aberrantly conduct to adjacent tissue, thereby disrupting the cardiac cycle into an asynchronous cardiac rhythm. Note that this asynchronous cardiac rhythm can also be detected as the IC ECG data. Such abnormal conduction has been previously known to occur at various regions of the heart  12 , for example, in the region of the sino-atrial (SA) node, along the conduction pathways of the atrioventricular (AV) node, or in the cardiac muscle tissue forming the walls of the ventricular and atrial cardiac chambers. There are other conditions, such as flutter, where the pattern of abnormally conducting tissues lead to reentry paths such that the chamber beats in a regular pattern that can be multiple times the sinus rhythm. 
     By way of example, in support of the system  10  detecting, diagnosing, and/or treating cardiac conditions, the catheter  14  can be navigated by the physician  24  into the heart  12  of the patient  23  lying on the bed. For instance, the physician  24  can insert the shaft through the sheath, while manipulating a distal end of the shaft using the manipulator near the proximal end of the catheter  14  and/or deflection from the sheath. According to one or more embodiments, the catheter  14  can be fitted at the distal end of the shaft. The catheter  14  can be inserted through the sheath in a collapsed state and can be then expanded within the heart  12 . 
     Generally, electrical activity at a point in the heart  12  may be typically measured by advancing the catheter  14  containing an electrical sensor (e.g., the sensor  29 ) at or near its distal tip (e.g., the at least one electrode  26 ) to that point in the heart  12 , contacting the tissue with the sensor and acquiring data at that point. One drawback with mapping a cardiac chamber using a catheter type containing only a single, distal tip electrode is the long period of time required to accumulate data on a point-by-point basis over the requisite number of points required for a detailed map of the chamber as a whole. Accordingly, multiple-electrode catheters (e.g., the catheter  14 ) have been developed to simultaneously measure electrical activity at multiple points in the heart chamber. 
     The catheter  14 , which can include the at least one electrode  26  and a catheter needle coupled onto a body thereof, can be configured to obtain biometric data, such as electrical signals of an intra-body organ (e.g., the heart  12 ), and/or to ablate tissue areas of thereof (e.g., a cardiac chamber of the heart  12 ). Note that the electrodes  26  are representative of any like elements, such as tracking coils, piezoelectric transducer, electrodes, or combination of elements configured to ablate the tissue areas or to obtain the biometric data. According to one or more embodiments, the catheter  14  can include one or more position sensors that used are to determine trajectory information. The trajectory information can be used to infer motion characteristics, such as the contractility of the tissue. 
     Biometric data (e.g., patient biometrics, patient data, or patient biometric data) can include one or more of local activation times (LATs), electrical activity, topology, bipolar mapping, reference activity, ventricle activity, dominant frequency, impedance, or the like. The LAT can be a point in time of a threshold activity corresponding to a local activation, calculated based on a normalized initial starting point. Electrical activity can be any applicable electrical signals that can be measured based on one or more thresholds and can be sensed and/or augmented based on signal to noise ratios and/or other filters. A topology can correspond to the physical structure of a body part or a portion of a body part and can correspond to changes in the physical structure relative to different parts of the body part or relative to different body parts. A dominant frequency can be a frequency or a range of frequency that is prevalent at a portion of a body part and can be different in different portions of the same body part. For example, the dominant frequency of a PV of a heart can be different than the dominant frequency of the right atrium of the same heart. Impedance can be the resistance measurement at a given area of a body part. 
     Examples of biometric data include, but are not limited to, patient identification data, IC ECG data, bipolar intracardiac reference signals, anatomical and electrical measurements, trajectory information, body surface (BS) ECG data, historical data, brain biometrics, blood pressure data, ultrasound signals, radio signals, audio signals, a two- or three-dimensional (3D) image data, blood glucose data, and temperature data. The biometrics data can be used, generally, to monitor, diagnosis, and treatment any number of various diseases, such as cardiovascular diseases (e.g., arrhythmias, cardiomyopathy, and coronary artery disease) and autoimmune diseases (e.g., type I and type II diabetes). Note that BS ECG data can include data and signals collected from electrodes on a surface of a patient, IC ECG data can include data and signals collected from electrodes within the patient, and ablation data can include data and signals collected from tissue that has been ablated. Further, BS ECG data, IC ECG data, and ablation data, along with catheter electrode position data, can be derived from one or more procedure recordings. 
     For example, the catheter  14  can use the electrodes  26  to implement intravascular ultrasound and/or MRI catheterization to image the heart  12  (e.g., obtain and process the biometric data). The catheter  14  is shown in an enlarged view, inside a cardiac chamber of the heart  12 . It will be understood that any shape that includes one or more electrodes  26  can be used to implement the embodiments disclosed herein. 
     Examples of the catheter  14  include, but are not limited to, a linear catheter with multiple electrodes, a balloon catheter including electrodes dispersed on multiple spines that shape the balloon, a lasso, a catheter with electrodes in shape of a grid or loop catheter with multiple electrodes, a high density catheter, or any other applicable shape or complexity. Linear catheters can be fully or partially elastic such that it can twist, bend, and or otherwise change its shape based on received signal and/or based on application of an external force (e.g., cardiac tissue) on the linear catheter. The balloon catheter can be designed such that when deployed into a patient’s body, its electrodes can be held in intimate contact against an endocardial surface. As an example, a balloon catheter can be inserted into a lumen, such as a pulmonary vein (PV). The balloon catheter can be inserted into the PV in a deflated state, such that the balloon catheter does not occupy its maximum volume while being inserted into the PV. The balloon catheter can expand while inside the PV, such that those electrodes on the balloon catheter are in contact with an entire circular section of the PV. Such contact with an entire circular section of the PV, or any other lumen, can enable efficient imaging and/or ablation. Other examples of the catheter  14  include PentaRay® catheter and Constellation catheter. 
     According to other examples, body patches and/or body surface electrodes (e.g., the one or more electrode patches  38 ) may also be positioned on or proximate to a body of the patient  23 . The catheter  14  with the one or more electrodes  26  can be positioned within the body (e.g., within the heart  12 ) and a position of the catheter  14  can be determined by the  100  system based on signals transmitted and received between the one or more electrodes  26  of the catheter  14  and the body patches and/or body surface electrodes. Additionally, the electrodes  26  can sense the biometric data from within the body of the patient  23 , such as within the heart  12  (e.g., the electrodes  26  sense the electrical potential of the tissue in real time). The biometric data can be associated with the determined position of the catheter  14  such that a rendering of the patient’s body part (e.g., the heart  12 ) can be displayed and show the biometric data overlaid on a shape of the body part. 
     By way of further example, the catheter  14  and other items of the system  10  can be connected to the workstation  55 . The workstation  55  can include any computing device, which employs the ML/AI algorithm (which can be included within the generation engine  101 ). According to an exemplary embodiment, the workstation  55  includes the one or more processors  61  (any computing hardware) and the memory  62  (any non-transitory tangible media), where the one or more processors  61  execute computer instructions with respect the generation engine  101  and the memory  62  stores these instructions for execution by the one or more processors  61 . For instance, the workstation  55  can be configured to receive and process the biometric data and determine if a given tissue area conducts electricity. In some embodiments, the workstation  55  can be further programmed by the generation engine  101  (in software) to carry out the functions of an ablation procedure guidance method. For example, the ablation procedure guidance method can include receiving inputs (e.g., including one or more images and conduction velocity vector estimations), generating a digital twin of an anatomical structure utilizing the images and the conduction velocity vector estimations, and presenting the digital twin to provide precision ablation guidance of the anatomical structure and provide electrophysiology information of the anatomical structure. 
     According to one or more embodiments, the generation engine  101  can be external to the workstation  55  and can be located, for example, in the catheter  14 , in an external device, in a mobile device, in a cloud-based device, or can be a standalone processor. In this regard, the generation engine  101  can be transferable/downloaded in electronic form, over a network. 
     In an example, the workstation  55  can be any computing device, as noted herein, including software (e.g., the generation engine  101 ) and/or hardware (e.g., the processor  61  and the memory  62 ), such as a general-purpose computer, with suitable front end and interface circuits for transmitting and receiving signals to and from the catheter  14 , as well as for controlling the other components of the system  10 . For example, the front end and interface circuits include input/output (I/O) communication interfaces that enables the workstation  55  to receive signals from and/or transfer signals to the at least one electrode  26 . The workstation  55  can include real-time noise reduction circuitry typically configured as a field programmable gate array (FPGA), followed by an analog-to-digital (A/D) ECG or electrocardiograph/electromyogram (EMG) signal conversion integrated circuit. The workstation  55  can pass the signal from an A/D ECG or EMG circuit to another processor and/or can be programmed to perform one or more functions disclosed herein. 
     The display device  27 , which can be any electronic device for the visual presentation of the biometric data, is connected to the workstation  55 . According to an exemplary embodiment, during a procedure, the workstation  55  can facilitate on the display device  27  a presentation of a body part rendering to the physician  24  and store data representing the body part rendering in the memory  62 . For instance, maps depicting motion characteristics can be rendered/constructed based on the trajectory information sampled at a sufficient number of points in the heart  12 . As an example, the display device  27  can include a touchscreen that can be configured to accept inputs from the medical professional  115 , in addition to presenting the body part rendering. 
     In some embodiments, the physician  24  may manipulate the elements of the system  10  and/or the body part rendering using one or more input devices, such as a touch pad, a mouse, a keyboard, a gesture recognition apparatus, or the like. For example, an input device can be used to change a position of the catheter  14 , such that rendering is updated. Note that the display device  27  can be located at a same location or a remote location, such as a separate hospital or in separate healthcare provider networks. 
     According to one or more embodiments, the system  10  can also obtain the biometric data using ultrasound, computed tomography (CT), MRI, or other medical imaging techniques utilizing the catheter  14  or other medical equipment. For instance, the system  10  can obtain ECG data and/or anatomical and electrical measurements of the heart  12  (e.g., the biometric data) using one or more catheters  14  or other sensors. More particularly, the workstation  55  can be connected, by a cable, to BS electrodes, which include adhesive skin patches affixed to the patient  23 . The BS electrodes can procure/generate the biometric data in the form of the BS ECG data. For instance, the processor  61  can determine position coordinates of the catheter  14  inside the body part (e.g., the heart  12 ) of the patient  23 . The position coordinates may be based on impedances or electromagnetic fields measured between the body surface electrodes and the electrode  26  of the catheter  14  or other electromagnetic components. Additionally, or alternatively, location pads, which generate magnetic fields used for navigation, may be located on a surface of a bed (or a table). and may be separate from the bed. The biometric data can be transmitted to the workstation  55  and stored in the memory  62 . Alternatively, or in addition, the biometric data may be transmitted to a server, which may be local or remote, using a network as further described herein. 
     According to one or more embodiments, the catheter  14  may be configured to ablate tissue areas of a cardiac chamber of the heart  12 . For instance, the catheter  14 , in an enlarged view, inside a cardiac chamber of the heart  12 . Further, ablation electrodes, such as the at least one electrode  26 , may be configured to provide energy to tissue areas of an intra-body organ (e.g., the heart  12 ). The energy may be thermal energy and may cause damage to the tissue area starting from the surface of the tissue area and extending into the thickness of the tissue area. The biometric data with respect to ablation procedures (e.g., ablation tissues, ablation locations, etc.) can be considered ablation data. 
     According to an example, with respect to obtaining the biometric data, a multi-electrode catheter (e.g., the catheter  14 ) can be advanced into a chamber of the heart  12 . Anteroposterior (AP) and lateral fluorograms can be obtained to establish the position and orientation of each of the electrodes. ECGs can be recorded from each of the electrodes  26  in contact with a cardiac surface relative to a temporal reference, such as the onset of the P-wave in sinus rhythm from a BS ECG and/or signals from electrodes  26  of the catheter  14  placed in the coronary sinus. The system, as further disclosed herein, may differentiate between those electrodes that register electrical activity and those that do not due to absence of close proximity to the endocardial wall. After initial ECGs are recorded, the catheter may be repositioned, and fluorograms and ECGs may be recorded again. An electrical map (e.g., via cardiac mapping) can then be constructed from iterations of the process above. 
     Cardiac mapping can be implemented using one or more techniques. Generally, mapping of cardiac areas such as cardiac regions, tissue, veins, arteries and/or electrical pathways of the heart  12  may result in identifying problem areas such as scar tissue, arrhythmia sources (e.g., electric rotors), healthy areas, and the like. Cardiac areas may be mapped such that a visual rendering of the mapped cardiac areas is provided using a display, as further disclosed herein. Additionally, cardiac mapping (which is an example of heart imaging) may include mapping based on one or more modalities such as, but not limited to LAT, local activation velocity, an electrical activity, a topology, a bipolar mapping, a dominant frequency, or an impedance. Data (e.g., biometric data) corresponding to multiple modalities may be captured using a catheter (e.g., the catheter  14 ) inserted into a patient’s body and may be provided for rendering at the same time or at different times based on corresponding settings and/or preferences of the physician  24 . 
     As an example of a first technique, cardiac mapping may be implemented by sensing an electrical property of heart tissue, for example, LAT, as a function of the precise location within the heart  12 . The corresponding data (e.g., biometric data) may be acquired with one or more catheters (e.g., the catheter  14 ) that are advanced into the heart  12  and that have electrical and location sensors (e.g., the electrodes  26 ) in their distal tips. As specific examples, location and electrical activity may be initially measured on about  10  to about  20  points on the interior surface of the heart  12 . These data points may be generally sufficient to generate a preliminary reconstruction or map of the cardiac surface to a satisfactory quality. The preliminary map may be combined with data taken at additional points to generate a more comprehensive map of the heart’s electrical activity. In clinical settings, it is not uncommon to accumulate data at  100  or more sites (e.g., several thousand) to generate a detailed, comprehensive map of heart chamber electrical activity. The generated detailed map may then serve as the basis for deciding on a therapeutic course of action, for example, tissue ablation as described herein, to alter the propagation of the heart’s electrical activity and to restore normal heart rhythm. 
     Further, cardiac mapping can be generated based on detection of intracardiac electrical potential fields (e.g., which is an example of IC ECG data and/or bipolar intracardiac reference signals). A non-contact technique to simultaneously acquire a large amount of cardiac electrical information may be implemented. For example, a catheter type having a distal end portion may be provided with a series of sensor electrodes distributed over its surface and connected to insulated electrical conductors for connection to signal sensing and processing means. The size and shape of the end portion may be such that the electrodes are spaced substantially away from the wall of the cardiac chamber. Intracardiac potential fields may be detected during a single cardiac beat. According to an example, the sensor electrodes may be distributed on a series of circumferences lying in planes spaced from each other. These planes may be perpendicular to the major axis of the end portion of the catheter. At least two additional electrodes may be provided adjacent at the ends of the major axis of the end portion. As a more specific example, the catheter may include four circumferences with eight electrodes spaced equiangularly on each circumference. Accordingly, in this specific implementation, the catheter may include at least 34 electrodes ( 32  circumferential and 2 end electrodes). As another more specific example, the catheter may include other multi-spline catheters, such as five soft flexible branches, eight radial splines, or a parallel splined pancake turner type (e.g., any of which may have a total of 42 electrodes). 
     As example of electrical or cardiac mapping, an electrophysiological cardiac mapping system and technique based on a non-contact and non-expanded multi-electrode catheter (e.g., the catheter  14 ) can be implemented. ECGs may be obtained with one or more catheters  14  having multiple electrodes (e.g., such as between 42 to 122 electrodes). According to this implementation, knowledge of the relative geometry of the probe and the endocardium can be obtained by an independent imaging modality, such as transesophageal echocardiography. After the independent imaging, non-contact electrodes may be used to measure cardiac surface potentials and construct maps therefrom (e.g., in some cases using bipolar intracardiac reference signals). This technique can include the following steps (after the independent imaging step): (a) measuring electrical potentials with a plurality of electrodes disposed on a probe positioned in the heart  12 ; (b) determining the geometric relationship of the probe surface and the endocardial surface and/or other reference; (c) generating a matrix of coefficients representing the geometric relationship of the probe surface and the endocardial surface; and (d) determining endocardial potentials based on the electrode potentials and the matrix of coefficients. 
     As another example of electrical or cardiac mapping, a technique and apparatus for mapping the electrical potential distribution of a heart chamber can be implemented. An intra-cardiac multi-electrode mapping catheter assembly can be inserted into the heart  12 . The mapping catheter (e.g., the catheter  14 ) assembly can include a multi-electrode array with one or more integral reference electrodes (e.g., one or the electrodes  26 ) or a companion reference catheter. 
     According to one or more embodiments, the electrodes may be deployed in the form of a substantially spherical array, which may be spatially referenced to a point on the endocardial surface by the reference electrode or by the reference catheter this is brought into contact with the endocardial surface. The preferred electrode array catheter may carry a number of individual electrode sites (e.g., at least  24 ). Additionally, this example technique may be implemented with knowledge of the location of each of the electrode sites on the array, as well as knowledge of the cardiac geometry. These locations are preferably determined by a technique of impedance plethysmography. 
     In view of electrical or cardiac mapping and according to another example, the catheter  14  can be a heart mapping catheter assembly that may include an electrode array defining a number of electrode sites. The heart mapping catheter assembly can also include a lumen to accept a reference catheter having a distal tip electrode assembly that may be used to probe the heart wall. The map heart mapping catheter assembly can include a braid of insulated wires (e.g., having 24 to 64 wires in the braid), and each of the wires may be used to form electrode sites. The heart mapping catheter assembly may be readily positionable in the heart  12  to be used to acquire electrical activity information from a first set of non-contact electrode sites and/or a second set of in-contact electrode sites. 
     Further, according to another example, the catheter  14  that can implement mapping electrophysiological activity within the heart can include a distal tip that is adapted for delivery of a stimulating pulse for pacing the heart or an ablative electrode for ablating tissue in contact with the tip. This catheter  14  can further include at least one pair of orthogonal electrodes to generate a difference signal indicative of the local cardiac electrical activity adjacent the orthogonal electrodes. 
     As noted herein, the system  10  can be utilized to detect, diagnose, and/or treat cardiac conditions. In example operation, a process for measuring electrophysiologic data in a heart chamber may be implemented by the system  10 . The process may include, in part, positioning a set of active and passive electrodes into the heart  12 , supplying current to the active electrodes, thereby generating an electric field in the heart chamber, and measuring the electric field at the passive electrode sites. The passive electrodes are contained in an array positioned on an inflatable balloon of a balloon catheter. In preferred embodiments, the array is said to have from 60 to 64 electrodes. 
     As another example operation, cardiac mapping may be implemented by the system  10  using one or more ultrasound transducers. The ultrasound transducers may be inserted into a patient’s heart  12  and may collect a plurality of ultrasound slices (e.g., two dimensional or 3D slices) at various locations and orientations within the heart  12 . The location and orientation of a given ultrasound transducer may be known and the collected ultrasound slices may be stored such that they can be displayed at a later time. One or more ultrasound slices corresponding to the position of the catheter  14  (e.g., a treatment catheter) at the later time may be displayed and the catheter  14  may be overlaid onto the one or more ultrasound slices. 
     In view of the system  10 , it is noted that cardiac arrhythmias, including atrial arrhythmias, may be of a multiwavelet reentrant type, characterized by multiple asynchronous loops of electrical impulses that are scattered about the atrial chamber and are often self-propagating (e.g., another example of the IC ECG data). Alternatively, or in addition to the multiwavelet reentrant type, cardiac arrhythmias may also have a focal origin, such as when an isolated region of tissue in an atrium fires autonomously in a rapid, repetitive fashion (e.g., another example of the IC ECG data). Ventricular tachycardia (V-tach or VT) is a tachycardia, or fast heart rhythm that originates in one of the ventricles of the heart. This is a potentially life-threatening arrhythmia because it may lead to ventricular fibrillation and sudden death. 
     For example, aFib occurs when the normal electrical impulses (e.g., another example of the IC ECG data) generated by the sinoatrial node are overwhelmed by disorganized electrical impulses (e.g., signal interference) that originate in the atria veins and PVs causing irregular impulses to be conducted to the ventricles. An irregular heartbeat results, and may last from minutes to weeks, or even years. aFib is often a chronic condition that leads to a small increase in the risk of death often due to strokes. A line of treatment for aFib is medication that either slows the heart rate or revert the heart rhythm back to normal. Additionally, persons with aFib are often given anticoagulants to protect them from the risk of stroke. The use of such anticoagulants comes with its own risk of internal bleeding. In some patients, medication is not sufficient and their aFib is deemed to be drug-refractory, i.e., untreatable with standard pharmacological interventions. Synchronized electrical cardioversion may also be used to convert aFib to a normal heart rhythm. Alternatively, aFib patients are treated by catheter ablation. 
     A catheter ablation-based treatment may include mapping the electrical properties of heart tissue, especially the endocardium and the heart volume, and selectively ablating cardiac tissue by application of energy. Electrical or cardiac mapping (e.g., implemented by any electrophysiological cardiac mapping system and technique described herein) includes creating a map of electrical potentials (e.g., a voltage map) of the wave propagation along the heart tissue or a map of arrival times (e.g., a LAT map) to various tissue located points. Electrical or cardiac mapping (e.g., a cardiac map) may be used for detecting local heart tissue dysfunction. Ablations, such as those based on cardiac mapping, can cease or modify the propagation of unwanted electrical signals from one portion of the heart  12  to another. 
     The ablation process damages the unwanted electrical pathways by formation of nonconducting lesions. Various energy delivery modalities have been disclosed for forming lesions, and include use of microwave, laser and more commonly, radiofrequency energies to create conduction blocks along the cardiac tissue wall. Another example of an energy delivery technique includes irreversible electroporation (IRE), which provides high electric fields that damage cell membranes. In a two-step procedure (e.g., mapping followed by ablation) electrical activity at points within the heart  12  is typically sensed and measured by advancing the catheter  14  containing one or more electrical sensors (e.g., electrodes  26 ) into the heart  12  and obtaining/acquiring data at a multiplicity of points (e.g., as biometric data generally, or as ECG data specifically). This ECG data is then utilized to select the endocardial target areas, at which ablation is to be performed. 
     Cardiac ablation and other cardiac electrophysiological procedures have become increasingly complex as clinicians treat challenging conditions such as atrial fibrillation and ventricular tachycardia. The treatment of complex arrhythmias can now rely on the use of 3D mapping systems to reconstruct the anatomy of the heart chamber of interest. In this regard, the generation engine  101  employed by the system  10  herein manipulates and evaluates the biometric data generally, or the ECG data specifically, to produce improved tissue data that enables more accurate diagnosis, images, scans, and/or maps for treating an abnormal heartbeat or arrhythmia. For example, cardiologists rely upon software, such as the Complex Fractionated Atrial Electrograms (CFAE) module of the CARTO® 3 3D mapping system, produced by Biosense Webster, Inc. (Diamond Bar, Calif.), to generate and analyze ECG data. The generation engine  101  of the system  10  enhances this software to generate and analyze the improved biometric data, which further provide multiple pieces of information regarding electrophysiological properties of the heart  12  (including the scar tissue) that represent cardiac substrates (anatomical and functional) of aFib. 
     Accordingly, the system  10  can implement a 3D mapping system, such as CARTO® 3 3D mapping system, to localize the potential arrhythmogenic substrate of the cardiomyopathy in terms of abnormal ECG detection. The substrate linked to these cardiac conditions is related to the presence of fragmented and prolonged ECGs in the endocardial and/or epicardial layers of the ventricular chambers (right and left). For instance, areas of low or medium voltage may exhibit ECG fragmentation and prolonged activities. Further, during sinus rhythm, areas of low or medium voltage may corresponds to a critical isthmus identified during sustained and organized ventricular arrhythmias (e.g., applies to non-tolerated ventricular tachycardias, as well as in the atria). In general, abnormal tissue is characterized by low-voltage ECGs. However, initial clinical experience in endo-epicardial mapping indicates that areas of low-voltage are not always present as the sole arrhythmogenic mechanism in such patients. In fact, areas of low or medium voltage may exhibit ECG fragmentation and prolonged activities during sinus rhythm, which corresponds to the critical isthmus identified during sustained and organized ventricular arrhythmias, e.g., applies only to non-tolerated ventricular tachycardias. Moreover, in many cases, ECG fragmentation and prolonged activities are observed in the regions showing a normal or near-normal voltage amplitude (&gt;1-1.5 mV). Although the latter areas may be evaluated according to the voltage amplitude, they cannot be considered as normal according to the intracardiac signal, thus representing a true arrhythmogenic substrate. The 3D mapping may be able to localize the arrhythmogenic substrate on the endocardial and/or epicardial layer of the right/left ventricle, which may vary in distribution according to the extension of the main disease. 
     As another example operation, cardiac mapping may be implemented by the system  10  using one or more multiple-electrode catheters (e.g., the catheter  14 ). Multiple-electrode catheters are used to stimulate and map electrical activity in the heart  12  and to ablate sites of aberrant electrical activity. In use, the multiple-electrode catheter is inserted into a major vein or artery, e.g., femoral vein, and then guided into the chamber of the heart  12  of concern. A typical ablation procedure involves the insertion of the catheter  14  having at least one electrode  26  at its distal end, into a heart chamber. A reference electrode is provided, taped to the skin of the patient or by means of a second catheter that is positioned in or near the heart or selected from one or the other electrodes  26  of the catheter  14 . Radio frequency (RF) current is applied to a tip electrode  26  of the ablating catheter  14 , and current flows through the media that surrounds it (e.g., blood and tissue) toward the reference electrode. The distribution of current depends on the amount of electrode surface in contact with the tissue as compared to blood, which has a higher conductivity than the tissue. Heating of the tissue occurs due to its electrical resistance. The tissue is heated sufficiently to cause cellular destruction in the cardiac tissue resulting in formation of a lesion within the cardiac tissue which is electrically non-conductive. During this process, heating of the tip electrode  26  also occurs as a result of conduction from the heated tissue to the electrode itself. If the electrode temperature becomes sufficiently high, possibly above 60° C., a thin transparent coating of dehydrated blood protein can form on the surface of the electrode  26 . If the temperature continues to rise, this dehydrated layer can become progressively thicker resulting in blood coagulation on the electrode surface. Because dehydrated biological material has a higher electrical resistance than endocardial tissue, impedance to the flow of electrical energy into the tissue also increases. If the impedance increases sufficiently, an impedance rise occurs, and the catheter  14  must be removed from the body and the tip electrode  26  cleaned. 
     Turning now to  FIG.  2   , a diagram of a system  200  in which one or more features of the disclosure subject matter can be implemented is illustrated according to one or more embodiments. The system  200  can be configured to generate a digital twin of atria for aFib patients. 
     The system  200  includes, in relation to a patient  202  (e.g., an example of the patient  23  of  FIG.  1   ), an apparatus  204 , a local computing device  206 , a remote computing system  208 , a first network  210 , and a second network  211 . Further, the apparatus  204  can include a biometric sensor  221  (e.g., an example of the catheter  14  of  FIG.  1   ), a processor  222 , a user input (UI) sensor  223 , a memory  224 , and a transceiver  225 . Note that the generation engine  101  of  FIG.  1    is reused in  FIG.  2    for ease of explanation and brevity. 
     According to an embodiment, the apparatus  204  can be an example of the system  10  of  FIG.  1   , where the apparatus  204  can include both components that are internal to the patient and components that are external to the patient. According to another embodiment, the apparatus  204  can be an apparatus that is external to the patient  202  that includes an attachable patch (e.g., that attaches to a patient’s skin). According to another embodiment, the apparatus  204  can be internal to a body of the patient  202  (e.g., subcutaneously implantable), where the apparatus  204  can be inserted into the patient  202  via any applicable manner including orally injecting, surgical insertion via a vein or artery, an endoscopic procedure, or a laparoscopic procedure. According to an embodiment, while a single apparatus  204  is shown in  FIG.  2   , example systems may include a plurality of apparatuses. 
     Accordingly, the apparatus  204 , the local computing device  206 , and/or the remote computing system  208  can be programed to execute computer instructions with respect the generation engine  101 . As an example, the memory  223  stores these instructions for execution by the processor  222  so that the apparatus  204  can receive and process the biometric data via the biometric sensor  201 . In this way, the processor  222  and the memory  223  are representative of processors and memories of the local computing device  206  and/or the remote computing system  208 . 
     The apparatus  204 , local computing device  206 , and/or the remote computing system  208  can be any combination of software and/or hardware that individually or collectively store, execute, and implement the generation engine  101  and functions thereof. Further, the apparatus  204 , local computing device  206 , and/or the remote computing system  208  can be an electronic, computer framework comprising and/or employing any number and combination of computing device and networks utilizing various communication technologies, as described herein. The apparatus  204 , local computing device  206 , and/or the remote computing system  208  can be easily scalable, extensible, and modular, with the ability to change to different services or reconfigure some features independently of others. 
     The networks  210  and  211  can be a wired network, a wireless network, or include one or more wired and wireless networks. According to an embodiment, the network  210  is an example of a short-range network (e.g., local area network (LAN), or personal area network (PAN)). Information can be sent, via the network  210 , between the apparatus  204  and the local computing device  206  using any one of various short-range wireless communication protocols, such as Bluetooth, Wi-Fi, Zigbee, Z-Wave, near field communications (NFC), ultra-band, Zigbee, or infrared (IR). Further, the network  211  is an example of one or more of an Intranet, a local area network (LAN), a wide area network (WAN), a metropolitan area network (MAN), a direct connection or series of connections, a cellular telephone network, or any other network or medium capable of facilitating communication between the local computing device  206  and the remote computing system  208 . Information can be sent, via the network  211 , using any one of various long-range wireless communication protocols (e.g., TCP/IP, HTTP, 3G, 4G/LTE, or 5G/New Radio). Note that for either network  210  and  211  wired connections can be implemented using Ethernet, Universal Serial Bus (USB), RJ-11 or any other wired connection and wireless connections can be implemented using Wi-Fi, WiMAX, and Bluetooth, infrared, cellular networks, satellite or any other wireless connection methodology. 
     In operation, the apparatus  204  can continually or periodically obtain, monitor, store, process, and communicate via network  210  the biometric data associated with the patient  202 . Further, the apparatus  204 , local computing device  206 , and/ the remote computing system  208  are in communication through the networks  210  and  211  (e.g., the local computing device  206  can be configured as a gateway between the apparatus  204  and the remote computing system  208 ). For instance, the apparatus  204  can be an example of the system  10  of  FIG.  1    configured to communicate with the local computing device  206  via the network  210 . The local computing device  206  can be, for example, a stationary/standalone device, a base station, a desktop/laptop computer, a smart phone, a smartwatch, a tablet, or other device configured to communicate with other devices via networks  211  and  210 . The remote computing system  208 , implemented as a physical server on or connected to the network  211  or as a virtual server in a public cloud computing provider (e.g., Amazon Web Services (AWS) ®) of the network  211 , can be configured to communicate with the local computing device  206  via the network  211 . Thus, the biometric data associated with the patient  202  can be communicated throughout the system  200 . 
     Elements of the apparatus  204  are now described. The biometric sensor  221  may include, for example, one or more transducers configured to convert one or more environmental conditions into an electrical signal, such that different types of biometric data are observed/obtained/acquired. For example, the biometric sensor  221  can include one or more of an electrode (e.g., the electrode  26  of  FIG.  1   ), a temperature sensor (e.g., thermocouple), a blood pressure sensor, a blood glucose sensor, a blood oxygen sensor, a pH sensor, an accelerometer, and a microphone. 
     The processor  222 , in executing the generation engine  101 , can be configured to receive, process, and manage the biometric data acquired by the biometric sensor  221 , and communicate the biometric data to the memory  224  for storage and/or across the network  210  via the transceiver  225 . Biometric data from one or more other apparatuses  204  can also be received by the processor  222  through the transceiver  225 . Also, as described in more detail herein, the processor  222  may be configured to respond selectively to different tapping patterns (e.g., a single tap or a double tap) received from the UI sensor  223 , such that different tasks of a patch (e.g., acquisition, storing, or transmission of data) can be activated based on the detected pattern. In some embodiments, the processor  222  can generate audible feedback with respect to detecting a gesture. 
     According to one or more embodiments, the generation engine  101  upon execution can receive inputs including images and conduction velocity vector estimations, generate a digital twin of an anatomical structure utilizing the images and the conduction velocity vector estimations, and presenting, via a user interface, the digital twin to provide precision ablation guidance and electrophysiology information of the anatomical structure. 
     According to one or more embodiments, the generation engine  101  upon execution can perform re-estimation LAT activities based on the digital twin after performing one or more ablation (note that the ablation can be electroporation). In this case, the digital twin enables the generation engine  101  to generate a LAT map based on identifying a heartbeat source (e.g., a sinoatrial or SA node) and to calculate signal progress in the heart  12  based on the CV for each direction. One or more of the technical effects, advantages, and benefits of the generation engine  101 , thus, include enabling a real LAT map (as generated to day in CARTO ® 3) and a digital twin LAT map to be provided on the same interface. Further, after ablating, using ablation estimation models (such as CARTO VISITAG™ model), the CV of the ablated location can be updated by the generation engine  101 . Accordingly, the digital twin LAT map can also be updated based on 1250fthe CV updates. One or more of the technical effects, advantages, and benefits of the generation engine  101 , thus, include enabling a simulation of the LAT map after ablation without remapping the heart  14 . Thus, according to one or more embodiments, the generation engine  101  can generate the digital twin LAT map based on the digital twin model, and can update CV vector estimations of ablated cells/tissue in the digital twin model based on an ablation model that influenced the digital twin LAT map.  1250   
     The UI sensor  223  includes, for example, a piezoelectric sensor or a capacitive sensor configured to receive a user input, such as a tapping or touching. For example, the UI sensor  223  can be controlled to implement a capacitive coupling, in response to tapping or touching a surface of the apparatus  204  by the patient  202 . Gesture recognition may be implemented via any one of various capacitive types, such as resistive capacitive, surface capacitive, projected capacitive, surface acoustic wave, piezoelectric and infra-red touching. Capacitive sensors may be disposed at a small area or over a length of the surface, such that the tapping or touching of the surface activates the monitoring device. 
     The memory  224  is any non-transitory tangible media, such as magnetic, optical, or electronic memory (e.g., any suitable volatile and/or non-volatile memory, such as random-access memory or a hard disk drive). The memory  224  stores the computer instructions for execution by the processor  222 . 
     The transceiver  225  may include a separate transmitter and a separate receiver. Alternatively, the transceiver  225  may include a transmitter and receiver integrated into a single device. 
     In operation, the apparatus  204 , utilizing the generation engine  101 , observes/obtains the biometric data of the patient  202  via the biometric sensor  221 , stores the biometric data in the memory, and shares this biometric data across the system  200  via the transceiver  225 . The generation engine  101  can then utilize models, far field reduction algorithms, neural networks, ML, and/or AI to perform signal processing operations that generate a digital twin of atria for atrial fibrillation (aFib) patients. 
     Turning now to  FIG.  3   , a method  300  (e.g., performed by the generation engine  101  of  FIG.  1    and/or of  FIG.  2   ) is illustrated according to one or more embodiments. The method  300  can be an example of an ablation procedure guidance method for navigating atria of a heart. The method  300  addresses a need for improved ablation location determining techniques by providing a multi-step manipulation of electrical activity of the heart  12  (e.g., accounts for arrhythmia triggers, as well as information regarding atrial wall substances) that enables an improved understanding an electrophysiology with more precision via the digital twin. 
     The method begins at block  310 , where the generation engine  101  receives one or more inputs. The one or more inputs can include biometric data, as described herein, as well as one or more images (e.g., CTs, MRIs, etc.) of the heart  12 . The one or more inputs can be real-time data and patient specific. More particularly, the one or more inputs can include baseline recordings of IC ECG and/or BS ECG, previous/current CV vector estimations, and/or a lattice Boltzmann model for simulating typical waves propagating along the atria. According to one or more embodiments, the system  10  can utilize a multielectrode catheter (e.g., the catheter  14 ) to obtain multiple acquisitions (e.g., the baseline recordings) from a cardiac region covered by the electrodes. According to one or more embodiments, the inputs include images, conduction velocity vector estimations, and baseline recordings or a lattice Boltzmann model. Further, the inputs can be arrhythmogenic activity from IC ECG and/or BS ECG. 
     At block  320 , the generation engine  101  generates a digital twin. For example, the generation engine  101  creates a digital twin of a left atria of the heart  12  for the aFib patient  23 . The digital twin of the heart  12  can be based on the images and other inputs. According to one or more embodiments, the generation engine  101  generates the digital twin of the heart  12  utilizing the images and the conduction velocity vector estimations. The digital twin can also be based on the baseline recordings, the CV vector estimations, and/or the lattice Boltzmann model. Thus, once the generation engine  101  has the images and other inputs, the generation engine  101  can construct the anatomy to determine how the electricity flows through that anatomy. One or more operations of generating the digital twin at block  320  can include, but are not limited to, performing a direction of arrival (DOA) estimation ( 330 ), clustering ( 340 ), voxelizing ( 350 ), and dynamic 3D generation ( 360 ). In this regard, the generation engine  1010  determines electricity flows through the heart  12  based on performing one or more of DOA estimations, clustering, voxelizing, and dynamic three-dimensional generation. While the operations of generating the digital twin are described further herein, a brief explanation of each is provided for ease of understanding. 
     At blocks  330  and  340 , the DOA estimation and clustering can be a bottom-up approach to estimate local CV vectors by performing a segment-by-segment analysis of atrial activation from unipolar signals. Note that DOA estimations automatically identify CV vectors of arrhythmogenic activity (e.g., the system  10  can utilize DOA estimations to automatically identify the CV vectors estimations and to generate the digital twin). That is, once all segments are processed, the generation engine  101  clusters to detect DOA clusters (e.g., an output of the clustering can be 1-3 typical conduction velocity vectors). More particularly, the bottom-up stage approach outputs conduction velocity vectors and focal source location per points of electrophysiology measurements, with a last stage using Lattice Boltzmann Model for estimating patterns of electrical flows simulations based on focal source. 
     At block  350 , the generation engine  101  voxelizes (i.e., processes one or more voxels) to find a best CV vector. In this regard, the atria are voxelated into K voxels (i.e., the atria is divided into one or more voxels), and each voxel sees only its six immediate nearest neighbors. Further, the generation engine  101  uses a probability for seeing an activation wave in an immediate neighbor to determine the best CV vector. At block  360 , the generation engine  101  executes a dynamic 3D generation that presents a wave (along the best CV vector). In this regard, the digital twin that is built from the one or more inputs (e.g., the constructed anatomy from the images) is aligned with the dynamic 3D generation. 
     At block  370 , the generation engine  101  presents the digital twin in a user interface for the physician  24 . According to one or more embodiments, the generation engine  101  presents the digital twin to provide precision ablation guidance and provide electrophysiology information of the anatomical structure (i.e., the heart  12 ). For instance, the precision ablation guidance of the user interface can include one or more simulations showing how electricity flows through the digital twin based the conduction velocity vector estimations (e.g., based on the best CV vector) and/or one or more interactions between focal activities with respect to the digital twin and determining a foci for ablation based on the one or more interactions. More particularly, the generation engine  101  acts a guiding tool for an ablation procedure before any ablation is performed. In this way, the physician  24  can evaluate a real-time condition of the atria of the heart  12  and interact with the digital twin accordingly. 
     At block  380 , the generation engine  101  receives one or more additional inputs. The one or more additional inputs can be real-time data and patient specific. The one or more inputs can include biometric data, catheter movements, CT images, MRI images, real time ultrasound images, additional IC ECG and/or BS ECG recordings, and/or updated CV vector estimations. According to one or more embodiments, the generation engine  101  receives the one or more additional inputs and generates one or more different ablation approach suggestions for an ablation procedure, as well as performs a remapping operation of the digital twin (based on the one or more additional inputs). For example, the physician  24  makes one or more decisions after viewing the digital twin presented at block  370 , such as moving the catheter  14  to a new position. The generation engine  101  utilizes the new position and updated biometric information associated with the new position (as the one or more additional inputs) to generate simulations. The generation engine  101  simulates different ablation approaches and suggests one that reduces the arrhythmia with minimum area of ablation. The generation engine  101  simulates interaction between focal activities to determine which of the focal are more important for ablation. The technical effects and benefits of the method  300  include enabling the generation engine  101  to include actual scars using bipolar voltage map or simulated scars based on the assumption that the physician  24  is going to ablate in each location. According to one or more embodiments, the operations of block  380  can be optional. 
     At dashed-block  380  (optional), ablation occurs. This optional step can be performed by the physician  24 , based on the simulations presented at block  370  and  380  in accordance with the one or more additional inputs. After the one or more additional inputs are received and/or the ablation is performed, the generation engine  101  can perform a remapping operation (represented by arrow 395) by returning to block  320 . 
     All or part of the method  300  can be implemented by the generation engine  101  with respect to ML/AI as described herein.  FIG.  4    illustrates a graphical depiction of an AI system  400  according to one or more embodiments. As shown, the AI system  400  includes data  410  (e.g., biometric data) that can be stored on a memory or other storage unit. Further, the AI system  400  includes a machine  420  and a model  430 , which represent software aspects of the generation engine  101  of  FIGS.  1 - 2    (e.g., ML/AI algorithm therein), The machine  420  and the model  430  together can generate an outcome  440 . The AI system  400   can include hardware  450 , which can represent the catheter  14  of  FIG.  1   , the workstation  55  of  FIG.  1   , and/or the apparatus  204  of  FIG.  2   . The description of  FIGS.  4 - 5    is made with reference to  FIGS.  1 - 3    for ease of understanding where appropriate. In general, the ML/AI algorithms of the AI system  400  (e.g., as implemented by the generation engine  101  of  FIGS.  1 - 2   ) operate with respect to the hardware  450 , using the data  410 , to train the machine  420 , build the model  430 , and predict the outcomes  440 . 
     For instance, the machine  420  operates as software controller executing on the hardware  450 . The data  410  (e.g., the biometric data as described herein) can be on-going data (i.e., data that is being continuously collected) or output data associated with the hardware  450 . The data  410  can also include currently collected data (e.g., position of the catheter  14 ), historical data, or other data from the hardware  450 ; can include measurements during a surgical procedure and may be associated with an outcome of the surgical procedure; can include a temperature of the heart  12  of  FIG.  1    collected and correlated with an outcome of a heart procedure (or one or more of LATs, electrical activity, topology, bipolar mapping, reference activity, ventricle activity, dominant frequency, impedance); and can be related to the hardware  450 . The data  410  can be divided by the machine  420  into one or more subsets. 
     Further, the machine  420  trains, which can include an analysis and correlation of the data  410  collected. For example, in the case of the heart, the data  410  of temperature and outcome may be trained to determine if a correlation or link exists between the temperature of the heart  12  of  FIG.  1    during the heart procedure and the positive or negative procedure outcome. In accordance with another embodiment, training the machine  420  can include self-training by the generation engine  101  of  FIG.  1    utilizing the one or more subsets. In this regard, for example, the generation engine  101  of  FIG.  1    learns to generate digital twins and simulate wave propagations. 
     Moreover, the model  430  is built on the data  410 . Building the model  430  can include physical hardware or software modeling, algorithmic modeling, and/or the like that seeks to represent the data  410  (or subsets thereof) that has been collected and trained. In some aspects, building of the model  430  is part of self-training operations by the machine  420 . The model  430  can be configured to model the operation of hardware  450  and model the data  410  collected from the hardware  450  to predict the outcome  440  achieved by the hardware  450 . Predicting the outcomes  440  (of the model  430  associated with the hardware  450 ) can utilize a trained model  430 . For example and to increase understanding of the disclosure, in the case of the heart, if the temperature during the procedure that is between 36.5° C. and 37.89° C. (i.e., 97.7° F. and 100.2° F.) produces more positive results from the heart procedure, the outcome  440  may be predicted in a given procedure using these temperatures. Thus, using the outcome  440  that is predicted, the machine  420 , the model  430 , and the hardware  450  can be configured accordingly. 
     Thus, for the AI system  400  to operate as described, the ML/AI algorithms therein can include neural networks. In general, a neural network is a network or circuit of neurons, or in a modern sense, an artificial neural network (ANN), composed of artificial neurons or nodes or cells. 
     For example, an ANN involves a network of processing elements (artificial neurons) which can exhibit complex global behavior, determined by the connections between the processing elements and element parameters. These connections of the network or circuit of neurons are modeled as weights. A positive weight reflects an excitatory connection, while negative values mean inhibitory connections. Inputs are modified by a weight and summed using a linear combination. An activation function may control the amplitude of the output. For example, an acceptable range of output is usually between 0 and 1, or it could be -1 and 1. In most cases, the ANN is an adaptive system that changes its structure based on external or internal information that flows through the network. 
     In more practical terms, neural networks are non-linear statistical data modeling or decision-making tools that can be used to model complex relationships between inputs and outputs or to find patterns in data. Thus, ANNs may be used for predictive modeling and adaptive control applications, while being trained via a dataset. Note that self-learning resulting from experience can occur within ANNs, which can derive conclusions from a complex and seemingly unrelated set of information. The utility of artificial neural network models lies in the fact that they can be used to infer a function from observations and also to use it. Unsupervised neural networks can also be used to learn representations of the input that capture the salient characteristics of the input distribution, and more recently, deep learning algorithms, which can implicitly learn the distribution function of the observed data. Learning in neural networks is particularly useful in applications where the complexity of the data (e.g., the biometric data) or task (e.g., monitoring, diagnosing, and treating any number of various diseases) makes the design of such functions by hand impractical. 
     For the AI system  400 , the ML/AI algorithms therein can include neural networks that are divided generally according to tasks to which they are applied. These divisions tend to fall within the following categories: regression analysis (e.g., function approximation) including time series prediction and modeling; classification including pattern and sequence recognition; novelty detection and sequential decision making; data processing including filtering; clustering; blind signal separation, and compression. For example, application areas of ANNs include medical diagnosis and treatment to assist with creating a semantic profile of patient biometric data emerging from medical procedures. 
     According to one or more embodiments, the neural network can implement a long short-term memory neural network architecture, a convolutional neural network (CNN) architecture, or other the like. The neural network can be configurable with respect to a number of layers, a number of connections (e.g., encoder/decoder connections), a regularization technique (e.g., dropout); and an optimization feature. 
     The long short-term memory neural network architecture includes feedback connections and can process single data points (e.g., such as images), along with entire sequences of data (e.g., such as speech or video). A unit of the long short-term memory neural network architecture can be composed of a cell, an input gate, an output gate, and a forget gate, where the cell remembers values over arbitrary time intervals and the gates regulate a flow of information into and out of the cell. 
     The CNN architecture is a shared-weight architecture with translation invariance characteristics where each neuron in one layer is connected to all neurons in the next layer. The regularization technique of the CNN architecture can take advantage of the hierarchical pattern in data and assemble more complex patterns using smaller and simpler patterns. If the neural network implements the CNN architecture, other configurable aspects of the architecture can include a number of filters at each stage, kernel size, a number of kernels per layer. 
     Turning now to  FIG.  5   , an example of a neural network  500  and a block diagram of a method  501  performed in the neural network  500  are shown according to one or more embodiments. The neural network  500  operates to support implementation of the ML/AI algorithms (e.g., as implemented by the generation engine  101  of  FIGS.  1 - 2   ) described herein. The neural network  500  can be implemented in hardware, such as the machine  420  and/or the hardware  450  of  FIG.  4   . As indicated herein, the description of  FIGS.  4 - 5    is made with reference to  FIGS.  1 - 3    for ease of understanding where appropriate. 
     In an example operation, the generation engine  101  of  FIG.  1    includes collecting the data  410  from the hardware  450 . In the neural network  500 , an input layer  510  is represented by a plurality of inputs (e.g., inputs  512  and  514  of  FIG.  5   ). With respect to block  520  of the method  501 , the input layer  510  receives the inputs  512  and  514 . The inputs  512  and  514  can include biometric data. For example, the collecting of the data  410  can be an aggregation of biometric data (e.g., BS ECG data, IC ECG data, and ablation data, along with catheter electrode position data), from one or more procedure recordings of the hardware  450  into a dataset (as represented by the data  410 ). 
     At block  525  of the method  501 , the neural network  500  encodes the inputs  512  and  514  utilizing any portion of the data  410  (e.g., the dataset and predictions produced by the AI system  400 ) to produce a latent representation or data coding. The latent representation includes one or more intermediary data representations derived from the plurality of inputs. According to one or more embodiments, the latent representation is generated by an element-wise activation function (e.g., a sigmoid function or a rectified linear unit) of the generation engine  101  of  FIG.  1   . As shown in  FIG.  5   , the inputs  512  and  514  are provided to a hidden layer  530  depicted as including nodes  532 ,  534 ,  536 , and  538 . The neural network  500  performs the processing via the hidden layer  530  of the nodes  532 ,  534 ,  536 , and  538  to exhibit complex global behavior, determined by the connections between the processing elements and element parameters. Thus, the transition between layers  510  and  530  can be considered an encoder stage that takes the inputs  512  and  514  and transfers it to a deep neural network (within layer  530 ) to learn some smaller representation of the input (e.g., a resulting the latent representation). 
     The deep neural network can be a CNN, a long short-term memory neural network, a fully connected neural network, or combination thereof. The inputs  512  and  514  can be intracardiac ECG, body surface ECG, or intracardiac ECG and body surface ECG. This encoding provides a dimensionality reduction of the inputs  512  and  514 . Dimensionality reduction is a process of reducing the number of random variables (of the inputs  512  and  514 ) under consideration by obtaining a set of principal variables. For instance, dimensionality reduction can be a feature extraction that transforms data (e.g., the inputs  512  and  514 ) from a high-dimensional space (e.g., more than  10  dimensions) to a lower-dimensional space (e.g., 2-3 dimensions). The technical effects and benefits of dimensionality reduction include reducing time and storage space requirements for the data  410 , improving visualization of the data  410 , and improving parameter interpretation for ML. This data transformation can be linear or nonlinear. The operations of receiving (block  520 ) and encoding (block  525 ) can be considered a data preparation portion of the multi-step data manipulation by the generation engine  101 . 
     At block  545  of the method  510 , the neural network  500  decodes the latent representation. The decoding stage takes the encoder output (e.g., the resulting the latent representation) and attempts to reconstruct some form of the inputs  512  and  514  using another deep neural network. In this regard, the nodes  532 ,  534 ,  536 , and  538  are combined to produce in the output layer  550  an output  552 , as shown in block 560 of the method  510 . That is, the output layer  590  reconstructs the inputs  512  and  514  on a reduced dimension but without the signal interferences, signal artifacts, and signal noise. Examples of the output  552  include cleaned biometric data (e.g., clean/ denoised version of IC ECG data or the like). The technical effects and benefits of the cleaned biometric data include enabling more accurate monitor, diagnosis, and treatment any number of various diseases. 
     According to one or more embodiments, the generation engine  101  is described with respect to creating a digital twin of an atria of the heart  12  (e.g., Atria Digital Twin or ADT) for an aFib patient (e.g., the patient  120 ). As noted herein, aFib is a major global healthcare challenge. For example, aFib initiation and maintenance are incompletely understood, which has hindered the development of effective and reliable therapy. Treatment for aFib is often through catheter ablation, where the regions of myocardium determined to be responsible for initiating or perpetuating the disturbance are targeted and made electrically inactive through the localized application of radio-frequency energy or freezing. 
     For instance, for paroxysmal aFib, catheter ablation delivers relatively good outcomes, with success rates in a region of 80% to 90%. However, catheter ablation therapy for persistent aFib patients is less effective with success rates of approximately 50% despite all forms of adjunctive ablation strategies (also, approximately 33% of ablation procedures are performed in patients with persistent or long-standing persistent aFib). Pulmonary vein isolation (PVI) can be a first approach, but other ablation strategies are being developed to increase the effectiveness of the treatment for this segment of patients. 
     There are number of driving mechanisms responsible for aFib maintenance. Foci, rotors, and epi-endo disassociation. Recent clinical studies have targeted the foci, complex fractionated atrial electrograms (CFAE), and high dominant frequency (DF). However, none of these ablation strategies have been shown to add any value to the PVI approach. One or more reasons that these ablation strategies do not add value may include that these ablation strategies investigated only one modality in persistent aFib and connected that modality (e.g., simple or complex, focal behavior or non-focal behavior, early or late, fractionated or non-fractionated) to success or failure to obtain freedom from aFib after year or more from the ablation procedure, while much of the EP and ablation parameters being ignored. 
     The generation engine  101  overcomes these concerns by generating and providing an ADT for aFib patients (e.g., the patient  120 ). For example, the ADT models IC ECG data during baseline recordings of ablation procedure and creates match (e.g., like-for-like) of all available clinical observations. Base on the ADT, the generation engine  101  can test different ablation approaches and predict corresponding successes for acute and long-term termination of aFib. Accordingly, one or more advantages, technical effects, and/or benefits of the generation engine  101  includes a cost effective, safe, and ethical solution for ablation therapy investigation. That is, the generation engine  101  creates a patient specific model of an atrium (i.e., ADT). The patient specific model can address a number of challenges with respect to 3D representations, electrophysiology modeling, and other modeling of the atria. The generation engine  101  can, also, simulate a time varying contraction and conduction flow, simulate a hemodynamics flow of the atria, and apply the same when create digital twins of ventricles. The generation engine  101 , also, overcomes these concerns by using IC ECG, 3D imaging of the atria to estimate CV vectors, and a Lattice Boltzmann model for simulating N typical electrical flows that best fit the data. For example, the generation engine  101  can utilize and apply a deep learning algorithm to estimate the CV vectors per voxel from as set of  12  lead ECG signals. As noted herein with respect to  FIG.  5   , the generation engine  101  can include a ML/AI architecture for CV estimation from 3D anatomy, BC ECG, and 3D position of the BS electrodes. 
     According to one or more embodiments, the generation engine  101  generates, as the ADT, a digital twin of a left atria for aFib patients (e.g., the patient  120 ). This ADT is generated from baseline recordings of IC-ECG, CV vector estimation, and lattice Boltzmann model for simulating typical waves propagating along the left atria, as described herein (see at least  FIG.  3   ). The ADT can include actual scars using a bipolar voltage map or simulated scars based on the assumption that the physician  24  is going to ablate in each location. Therefore, the ADT can be used a guiding tool for ablation procedure. The ADT can, also, simulate different ablation approaches (across the ADT) and select one that reduces the arrhythmia with minimum area of ablation (e.g., an approach that has a smallest effective area). The ADT can simulate one or more interactions between focal activities (with respect to the atrial digital twin) to determine which of the focal are more important for ablation. Note that, given the nature of aFib, the ADT does not assume that an arrythmia repeats itself, such as in digital simulations based on anatomical information and assume a standard electrical conduction 
     Turning now to  FIG.  6   , a method  600  is illustrated according to one or more embodiments. Note that block  605  is dotted, indicating an input block; blocks  610 ,  615 ,  620 ,  625 ,  630 ,  635 ,  640 ,  645 ,  650 ,  675 , and  680  are dashed, indicating processing blocks; and blocks  655 ,  665 ,  670 , and  685  are dashed, indicating output blocks. The method  600  conducts velocity estimation and focal source detection based on DOA estimation (i.e., a process for CV and focal detection based on DOA estimation). Note that DOA can be considered a method for automatically identifying CV vectors of arrhythmogenic activity. Further, the method  600  can be a bottom-up approach to estimate local CV vectors, such as by using a multielectrode catheter to obtain multiple acquisitions from a cardiac region covered by the electrodes. 
     At block  605 , the generation engine  101  receives input recordings (e.g., multiple acquisitions from a cardiac region covered by the electrodes). At block  610 , the generation engine  101  performs an atrial detection per unipolar signal. At decision block  615 . the generation engine  101  performs a segment-by-segment analysis of atrial activation from the unipolar signals. 
     In parallel, at block  620 , the generation engine  101  further projects the catheter  14  into a 2D space. At determination block  625 , determines if there is a valid projection, such as the ratio of the sum of two dominant eigenvalues to the sum of three eigenvalues being higher than 95%. That is, if the generation engine  101  is not able to project into the 2D space, the method proceeds to block  630  (as shown by the NO arrow). Otherwise, the method  600  proceeds to block  635  (as shown by the YES arrow). At blocks  630  and  635 , a 3D or 2D weighted DOA model estimation is initiated based on the ability to project the catheter into a 2D space. 
     At decision block  640 , the generation engine  101  determines whether the estimation error of the model (e.g., ADT) is high or low. If the estimation error of the model is too high (e.g., greater than 7 milliseconds or msec), then the method  600  proceeds to block  645  (as shown by the NO arrow). At block  645 , an iterative mode for DOA estimation is applied. Iterative mode for DOA estimation is illustrated with respect to  FIGS.  11 - 14   . 
     At decision block  650 , the generation engine  101  again determines whether the estimation error of the model (e.g., ADT) is high or low (e.g., greater than 7 msec). If the estimation error of the model is too high (e.g., greater than 7 msec), then the method  600  proceeds to output block  655  (as shown by the NO arrow). At output block  655 , the generation engine  101  stores any bad segments for/from the DOA. 
     If a valid DOA is detected at block  640  and or  650  (as shown by the YES arrow), the LAT are corrected at output block  665 . At output block  670 , one or more DOA points are also stored in the memory  62  until all segments are processed. For instance, the method  600  can loop into decision block  615 , such as to finish all segments. 
     At block  675 , once all segments are processed (see Arrow 676), a k-means clustering is performed for the detection of DOA clusters. The k-means clustering can give/provide/generate typical CV vectors per location of the catheter  14  (e.g., a PentaRay® catheter). At block  680 , the generation engine  101  executes a detection stage where a focal source detection is initiated (i.e., if an origin of one or more of dominant CV vectors falls within 8 mm from a center of the catheter  14 , then a mechanism of focal validation is applied). At output block  685 , the generation engine  101  can validate focal sources (e.g., if there are  10  or more earliest S-wave patterns in electrodes in its vicinity). 
     According to one or more embodiments, DOA estimation, foci detection, and LAT improvements, as well as other aspect of  FIG.  6   , are further described herein. 
     Regarding a per segment DOA, a model base DOA can be applied for each segment of data. For instance, the model base DOA can include a set of at least  10  local atrial activation with t i  being a time of local atrial activity of the i electrode, i = 1, ... , m  10  ≤ m ≤ N, where N is a number of valid electrodes in the catheter  14  (e.g., N =  20  for PentaRay® catheter). If the generation engine  101  assumes/determines that a single wave is originated from any point in 3D space and that the single wave travels toward the catheter  14  with a constant CV, then the generation engine  101  can define the J(θ) the “total cost” of the model according to Equation 1, where x i , y i , z i  are the coordinates of the location of the electrodes and x 0 , y 0 , z 0  are the coordinates of the location where the DOA is calculated. 
     
       
         
           
             
               
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     That is, the generation engine  101  further defines  
     
       
         
           
             
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       y/ ( Xi  - x 0 ) 2  + (y, -  Yo ) Z  + (z i  - z o ) z  as the distance from a DOA point located at (x 0 ,y 0 ,z 0 ) and arriving at t i  to the i electrode located at (x i , y i , z i ). The generation engine  101  further defines t 0  as the bias time of arrival for all electrodes and v is ⅟CV of the wave. The term  
     
       
         
           
             
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     in J(θ) is a regularization term that is prefers solutions that are closer to an origin of the catheter  14  and increases a probability to find solutions within the anatomy of the atria. A purpose of the model base DOA is to minimize the total cost J(θ) by finding the “best”  
     
       
         
           
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     , that minimizes the total cost J(θ). The generation engine  101  achieve this purpose by using a gradient descent estimation procedure with a constraint that v is greater than 0. Gradient descent can be based on the observation that if the multivariable function J(θ k ) at the k′th iteration is defined and differentiable in a neighborhood of a point θ k , then J(θ k ) decreases fastest from θ k  in the direction of the negative gradient of J(θ k ) according to Equation 2. 
     
       
         
           
             
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     Not that V represents a differential operation, and y is the learning rate factor. y can be small to ensure conversion and not too small to overcome slow conversion or convergence to a local minimum of J(θ). According to one or more embodiments, a formal description of gradient descent algorithm can include deriving adifferential equation of J(θ) with respect to each one of the parameters (x 0 , y 0 , z 0 , t 0 , v) hence, as shown below by Equations 3-7, respectively. 
     
       
         
           
             
               
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       FIGS.  7 - 11    illustrate interfaces  700 ,  800 ,  900 ,  1000 , and  1100  according to one or more embodiments. The interfaces  700 ,  800 ,  900 ,  1000 , and  1100  can be generated by the generation engine  101 . The interface  700  of  FIG.  7    shows an example of DOA estimation based on a segment of atrial activity. First portion  710  of the interface  700  provides a set of unipolar signals with location of local activation time (t i  - circles) and their corresponding estimated- local activation time based on DOA model (squares). An upper figure  720  of the interface  700  depicts the estimated focal activity (circle with x inside). The other circles represent location of electrodes in X-Y space. An lower figure  730  of the interface  700  represents the actual location of the catheter  14  on the anatomy of the left atria. 
     The interface  800  of  FIG.  8    shows an example isochrone map. A wave is propagating from a circle  810  with an x inside. Each circle represents time of arrival in milliseconds (msec) according to a shaded-bar. One or more circles  830  represent location of electrodes, with a number therein representing an estimation error in msec. 
     According to one or more embodiments, the generation engine  101  can modify the above model base DOA with respect to dimensionality reduction, weighted DOA estimation, and/or DOA Iterative mode. 
     Regarding dimensionality reduction, the catheter  14  can be projected to a surface. Projection is performed by the generation engine  101  taking two eigen vectors with highest eigen values. If energy preserved by the two eigenvalues is greater than 95%, then the generation engine  101  assumes/determines that a projection from 3D space to a surface is valid with respect to θ = (x 0 , y 0 , z 0 , t 0 , ν), without the z dimension, as shown by Equations 8-13. 
     
       
         
           
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     Turning now to  FIG.  9   , the interface  900  is shown according to one or more embodiments. The interface  900  relates to an example of 2D DOA estimation (where 97.7% of the energy is preserved so a 2D DOA estimation is applied). A first portion  910  of the interface  900  provides unipolar signals sorted based on t i , where the rectangles represents estimated t i  based on estimation of x 0 , y 0 , z 0 , t 0 , and v. In the example shown by interface  900 , a single wave traveling toward the catheter  14 . An upper figure  920  of the interface  900  depicts the estimated focal activity (circle with x inside). The circles represent location of electrodes in X-Y space. An lower figure  930  of the interface  900  represents the actual location of the catheter  14  on the anatomy of the left atria. 
     Regarding Weighted DOA estimation, the generation engine  101  provides a “sharp” activation that is more “reliable” than a shallow activation, where a level of sharpness can be defined based dv/dt of the unipolar signal at t i . Each t i  can be mapped to a weight between 0 to 1 based on a corresponding dv/dt. An alternation can be set for the 2D according to equations 14-18. 
     
       
         
           
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     Turning to  FIG.  10   , the interface  1000  is shown according to one or more embodiments. The interface  1000  is an example of a Weighted DOA that was detected as focal activity. The graphs of the interface  1100  provide signals respective to electrodes (e.g., B5, B7, D13, C10, etc.) In the interface  1000 , notice that earliest S-wave pattern at electrodes E19 and E20. In a chart  1001  of the interface  1000 , each circle can represent to a weight of a slope. 
     Regarding DOA Iterative mode, if an average estimation error is above a certain threshold (e.g., 7 msec), then the generation engine  101  enters an iterative mode for DOA estimation. In each iteration, a local activation time with highest estimation error is removed from the DOA estimation. The process can be repeated, while there are more than  10  valid local activation times. 
     Turning to  FIG.  11   , the interface  1100  is shown according to one or more embodiments. The interface is an example of how to display information respective to an estimation of focal activity in a center of the catheter  14 . Note that due to a high estimation error of 12.4 msec, the generation engine  101  initiates an iterative mode. The graphs of the interface  1100  provide signals that represent a specific heart beat and activation time (i.e., a time that the signal passed bellow each pair of electrodes). A 3D image of the interface  1100  represents a location of each electrode in a left atria. A 2D image of the interface  1100  presented in a graph represents the position of each electrodes pair on the surface and the relative activation time. 
     Turning to  FIG.  12   , one or more graphs  1210 ,  1230 , and  1250  are shown according to one or more embodiments. The one or more graphs  1210 ,  1230 , and  1250  illustrate a first iteration of the focal source (e.g., at the center of the catheter  14 ), as well as second to ninth iterations of focal activity (e.g., which is shifted and placed near an electrode). The graph  1210  depicts a max error per iteration. The graph  1230  depicts a conduction velocity per iteration. Both graph  1210  and  1230  combine to show an overall convergence of the model to a “reasonable solution” (the maximum error dropped below 5 msec after the second iteration and the CV is 0.5 mm/msec). In graph  1250 , dots  1260  represent valid electrodes for DOA estimation, electrodes represent invalid electrodes, and “iter 9” represent that this electrode was eliminated from DOA estimation at iteration 9. Note that the iterative model is used to handle cases of noisy local activation time or cases with more than one wave propagating toward the catheter  14 . 
     Turning to  FIG.  13   , the interface  1300  shows an example of a DOA solution at iteration 9 (i.e., an actual results of the model). The graphs  1301  provide signals that represent a specific heart beat and activation time (i.e., a time that the signal passed bellow each pair of electrodes). A 3D image  1305  represents a location of each electrode in a left atria, and a 2D image  1310  presented in a graph represents the position of each electrodes pair on the surface and the relative activation time. According to one or more embodiments, the graphs  1301  unipolar signals after removing a far field activation (to dabble measured points). According to one or more embodiments, the signals can be procured by the catheter  14  having one or more splines and one or more electrodes per spline (e.g., an OCTARAY® mapping catheter with 48 electrodes). Estimation error of the model is an important quantity. Estimation error is a measure for a “goodness” of a fit of the model. When the final model yields an overall estimation error of above certain threshold (e.g., 7 msec), the generation engine  101  can assume that a segment is invalid for analysis. The percentage of invalid segments is a good measure for the “complexity” of the aFib in this subject. When using high density catheters and far field reduction algorithm, the “estimation error” can be calculated by the generation engine  101  per a group of electrodes or on a per electrode basis, where the “goodness” can be generated by each electrode. 
     With respect to the generation engine  101  moving from segment DOA to conduction velocity vectors, it is noted that the term DOA can represent the estimation of conduction velocity and (x, y) location of the wave that is propagating toward the catheter  14 . As noted herein, the generation engine  101  can provide an estimation of conduction velocity vector single segment of local atrial activation. A segment duration is typically 100-200 msec. Further, a typical recording has 2.5-30 seconds of unipolar signals and contains approximately 10-200 segments during aFib. Therefore, all valid DOA are stored until all segments are processed and then a k-means clustering is performed.  FIG.  14    and a graph 1400 depict an example of DOA clustering according to one or more embodiments. The generation engine  101  can execute a per recording based on clustering of DOA decision. Every circle represents DOA estimation from a segment of LAT within the recording. In this recording, there are two clusters of DOA that “explains” the data. The first cluster 1410 (circle at (-3.7 mm, -0.2 mm)) contains 80.5% of the DOAs, and the second cluster  1420  contains 19.5% of DOA in the recording. The output of the clustering is 1-3 typical CV vectors. 
     A focal source is detected, by the generation engine  101 , if the dominant cluster falls within an 8 mm radius from the center of the catheter  14 . A focal source may also be validated if at least  10  indications (configurable) of earliest S-wave patterns are found in electrodes located within a radius of 8 mm from the focal. Note that foci detection based DOA could manifested in location on the anatomy without placing a catheter in the focal activity therefore the validation process is optional. 
       FIG.  15    illustrates interfaces  1510  and  1540  according to one or more embodiments. The interface illustrate  1510  focal map. The interface  1540  illustrate conduction velocity static map. The maps of interfaces  1510  and  1540  are based on DOA algorithm presented on the left atria. 
     According to one or more embodiments, a Lattice-Boltzmann Model for Electrical flows simulations is described. The bottom-up stage of DTA algorithm of the generation engine  101  outputs CV vectors and focal source location per points of electrophysiology measurements, i.e., locations of measurements with PentaRay® catheter. The last stage of the algorithms of the generation engine  101  uses Lattice Boltzmann Model for estimating patterns of electrical flows simulations based on conduction velocity vectors. The atria are voxelated into K voxels and each voxel sees only its six immediate nearest neighbors. A measurement from previous stage is used to assign a set of possible conduction velocity vectors to each voxel. See Equation 19, where Øν represents M conduction velocity vectors associated with the voxel v. |Ø i | is the actual conduction velocity in V/sec and Ø ix , Ø iy  is their x and y components. 
     
       
         
           
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     For each time sample t, the generation engine  101  estimate per voxel the probability for an activation subject to the constraints of conduction velocity, cycle length and boundaries conditions. The generation engine  101  can assume that every voxel with bipolar voltage value below 0.5 mV is nonconductive and that the wave is restricted from activating this voxel. One or more boundary conditions could also be assumed, by the generation engine  101 , based on ablation points or ablation line given as an input to the algorithm from a user that is trying to simulate the best ablation approach. The generation engine  101  initiates operations/algorithms when the dominant voxel with focal source indication is “firing” at time 0. If there are none, focal sources are initiated based on clinical assumptions. For example, the generation engine  101   selects the Buchman bundle as the focal source location since it is the preferential path for electrical activation of the left atria during normal sinus rhythm. 
     The generation engine  101  determines/calculates a probability for seeing an activation wave in the immediate neighbors of the focal, according to Equation 20. 
     
       
         
           
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     e i  represents one of the 7 immediate nearest neighbors and dt is 1 msec in the system. If f(x+ e i , t + dt) = 1, the generation engine  101  estimates current CV of x + e i  (e.g., several methods can be applied by the generation engine  101 , such as collect information of the wave in the vicinity of voxel x + e i  in the last 20 msec). Next, by denoted θ = [|θ|, θ x , θ y ] as the estimated CV associated with voxel x + e i , then the CV criterion can be defined according to Equations 21-23. 
     
       
         
           
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     Note that α = 1 at the beginning of the estimation and that α is increased by a factor of two every time the Lattice Boltzmann Model fails to estimate a wave. If, for a given expected CV sample θ i , all the above criteria are met, then the CV velocity criteria is met and f(v + e i , t + dt) is equal to 1 (e.g., and if v + e i  is not a scar voxel). In turn, the generation engine  101  can implement a modified Lattice Boltzmann Model according to  FIG.  16    and method  1600 . 
     The method  1600  begins at block  620 , where the generation engine  101  voxelizes the atria set Øv for each voxel. At block 1640, the generation engine  101  sets an initial voxel of focal source. 
     Then, at block  1660 , the generation engine  101  determines, for each t, t ← t + dt. Further, at block  1660 , for every voxel v, if v + e i  is a scar voxel f(v + e i , t + dt)=0, break. Additionally, assume f(v, t) = 1; estimate θ; if the CV criteria met for voxel v + e i  at time t + dt then f(v + e i , t + dt)=1; if the CV criteria is not met, then f(v + e i , t + dt)=0. 
     At decision block  1680 , the generation engine  101  determines whether there is a valid wave. If so, the method  400  proceeds to block  1690  (as shown by the  1681  arrow), where the generation engine  101  utilizes a same α for the estimation (e.g., note that α = 1 at the beginning of the estimation). Otherwise, the method  400  proceeds to block  1695  (as shown by the NO arrow), where the generation engine  101  increases α and re-estimates with the higher α return. As noted herein, α can be increased by a factor of two every time the Lattice Boltzmann Model fails to estimate a wave (e.g., α, (α = α ▪ 2). 
     Regarding implementation, the generation engine  101  considers the CV for defining the overall firing rate of the focal source. Further, once a typical wave is estimated for a single cycle, the matrix Øν can be into two different matrices. For example, a first matrix can include only elements of Øν that met the conduction CV criteria, and a second matrix can include elements that did not meet the CV criteria. The second matrix can be used to create second simulation of the wave in aFib. 
     According to one or more embodiments, a digital twin of atria for an aFib patient can be a robust computer generated replica of the atria with personalized electrical activity to serve as a guiding tool for ablations. To generate and create the digital twin, the generation engine measures and utilizes the personalized electrical activity of the heart and CV vectors, while accounting for arrhythmia triggers and information regarding atrial wall substances. Then, during an ablation procedure, the generation engine continuous updates the digital twin, as well as suggest an optimal ablation and/or additional procedures based on the digital twin. As a result, the digital twin generated by the generation engine is very accurate compared to current digital simulations and can be used for effective guidance during ablation procedures by cardiac physicians and medical personnel. 
     According to one or more advantages and technical benefits, the generation engine  101  and the ADT can simulate different ablation approaches and select an approach that reduces the arrhythmia with minimum area of ablation. According to one or more advantages and technical benefits, the generation engine  101  updates, for each ablation line, a “scar” matrix and creates a simulation based on new boundaries. According to one or more advantages and technical benefits, the generation engine  101  provides/supports successful ablation approaches by reducing a duration of activation period with respect to atria cycle length. According to one or more advantages and technical benefits, the generation engine  101  and the model simulate interaction between focal activities to determine which of the focal are more important for ablation. 
     According to one or more embodiments, a method is provided. The method enables an improved understanding an electrophysiology of an anatomical structure with precision via a digital twin. The method is implemented by a generation engine executed by one or more processors. The method includes receiving one or more inputs. The one or more inputs include one or more images and conduction velocity vector estimations. The method includes generating the digital twin of the anatomical structure utilizing the one or more images and the conduction velocity vector estimations. The method includes presenting the digital twin in a user interface acting a guiding tool for a medical procedure. 
     According to one or more embodiments or any of the method embodiments herein, the one or more inputs can include baseline recordings, the conduction velocity vector estimations, or a lattice Boltzmann model for simulating typical waves propagating along the anatomical structure. 
     According to one or more embodiments or any of the method embodiments herein, the digital twin can be based on the baseline recordings, the conduction velocity vector estimations, or the lattice Boltzmann model. 
     According to one or more embodiments or any of the method embodiments herein, the digital twin can be generated to determine how the electricity flows through that anatomy based on performing one or more of a direction of arrival estimation, a clustering, a voxelizing, and dynamic three-dimensional generation. 
     According to one or more embodiments or any of the method embodiments herein, the DOA estimations can automatically identify the conduction velocity vectors estimations of arrhythmogenic activity from intracardiac electrocardiogram or body surface electrocardiogram. 
     According to one or more embodiments or any of the method embodiments herein, the user interface can provide one or more simulations with respect to the digital twin showing how electricity flows through the anatomical structure based on a best conduction velocity vector. 
     According to one or more embodiments or any of the method embodiments herein, the medical procedure can include at least an ablation procedure. 
     According to one or more embodiments or any of the method embodiments herein, the anatomical structure can include atria of a heart. 
     According to one or more embodiments or any of the method embodiments herein, the one or more inputs comprise patient specific data. 
     According to one or more embodiments or any of the method embodiments herein, the generation engine can receive one or more additional inputs. 
     According to one or more embodiments or any of the method embodiments herein, the generation engine can generate one or more different ablation approaches and suggestions for the medical procedure. 
     According to one or more embodiments or any of the method embodiments herein, the generation engine can execute a remapping operation of the digital twin based on the one or more additional inputs. 
     According to one or more embodiments or any of the method embodiments herein, the generation engine can generate a digital twin local activation times map based on a digital twin model. 
     According to one or more embodiments or any of the method embodiments herein, the generation engine can update conduction velocity vector estimations of ablated cells in the digital twin model based on an ablation model that influenced the digital twin local activation times map. 
     According to one or more embodiments or any of the method embodiments herein, the digital twin can be generated for atrial fibrillation patients. 
     According to one or more embodiments, a method is provided. The method enables an improved understanding an electrophysiology of an anatomical structure with precision via an atrial digital twin of an atrial of a heart. The method is implemented by a generation engine executed by one or more processors. The method includes generating the atrial digital twin utilizing one or more images and conduction velocity vector estimations and presenting the atrial digital twin in a user interface acting a guiding tool for a medical procedure. The method also includes simulating one or more different ablation approaches across the atrial digital twin and selecting an approach from the one or more different ablation approaches that reduces an arrhythmia with a minimum area of ablation. 
     According to one or more embodiments, a method is provided. The method enables an improved understanding an electrophysiology of an anatomical structure with precision via an atrial digital twin of an atrial of a heart. The method is implemented by a generation engine executed by one or more processors. The method includes generating the atrial digital twin utilizing one or more images and conduction velocity vector estimations and presenting the atrial digital twin in a user interface acting a guiding tool for a medical procedure. The method also includes simulating one or more interactions between focal activities with respect to the atrial digital twin and determining a foci based on the one or more interactions that is most important for ablation. 
     The flowchart and block diagrams in the Figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various embodiments of the present invention. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of instructions, which comprises one or more executable instructions for implementing the specified logical function(s). In some alternative implementations, the functions noted in the blocks may occur out of the order noted in the Figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts or carry out combinations of special purpose hardware and computer instructions. 
     Although features and elements are described above in particular combinations, one of ordinary skill in the art will appreciate that each feature or element can be used alone or in any combination with the other features and elements. In addition, the methods described herein may be implemented in a computer program, software, or firmware incorporated in a computer-readable medium for execution by a computer or processor. A computer readable medium, as used herein, is not to be construed as being transitory signals per se, such as radio waves or other freely propagating electromagnetic waves, electromagnetic waves propagating through a waveguide or other transmission media (e.g., light pulses passing through a fiber-optic cable), or electrical signals transmitted through a wire 
     Examples of computer-readable media include electrical signals (transmitted over wired or wireless connections) and computer-readable storage media. Examples of computer-readable storage media include, but are not limited to, a register, cache memory, semiconductor memory devices, magnetic media such as internal hard disks and removable disks, magneto-optical media, optical media such as compact disks (CD) and digital versatile disks (DVDs), a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), a static random access memory (SRAM), and a memory stick. A processor in association with software may be used to implement a radio frequency transceiver for use in a terminal, base station, or any host computer. 
     The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one more other features, integers, steps, operations, element components, and/or groups thereof. 
     The descriptions of the various embodiments herein have been presented for purposes of illustration, but are not intended to be exhaustive or limited to the embodiments disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the described embodiments. The terminology used herein was chosen to best explain the principles of the embodiments, the practical application or technical improvement over technologies found in the marketplace, or to enable others of ordinary skill in the art to understand the embodiments disclosed herein.