Physiology-Aware Graph Attention for Early Ventricular Reentry Prediction

Abstract

Sudden cardiac death mostly originates from post-infarct ventricular tachycardia. This reentry is sustained by propagation around scar tissue, but its risk remains difficult to predict from infarct imaging alone. While in silico induction studies can reveal these mechanisms, exploring many substrates and pacing locations remains computationally expensive. We propose a graph attention classifier for early prediction of sustained ventricular reentry from simulated cardiac electrophysiology. Each simulation is represented as a graph with early nodal voltage samples and edge attributes encoding geometry, stimulation frequency, tissue labels, amplitude, and diastolic interval. These descriptors are computed only from the first two paced activations, before sustained reentry is observed. On a balanced independent test set of 1000 simulations, the classifier achieves 94.6% accuracy, 95.4% sensitivity, 93.8% specificity, 94.6% F1-score, 0.987 ROC-AUC, and 0.985 PR-AUC. Ablation experiments show that diastolic interval is the most critical descriptor. Qualitative attention inspection suggests that different heads focus on border-zone, stimulation location, and early propagation path. These results support graph attention as a fast early-prediction approach for large-scale in silico ventricular reentry studies.