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ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

Reconstruction of Depolarization Pattern in Myocardial

Infarction Cases Using Two Cascaded Stages of Artificial
Neural Networks

Nihal A. Mabrouk1, Abdelreheem M. Khalifa2, Abdelmenem A. Nasser3,

and Moustafa H. Aly3
1
Electrical Engineering Department, Alexandria Institute for Engineering and Technology
(AIET), Alexandria, Egypt.
2
Electrical Engineering Department, Faculty of Engineering, Alexandria University, Egypt.
3
Electronics and Communications Engineering Department, Arab Academy for Science,
Technology and Maritime Transport, (AAST), Alexandria, Egypt.

*Corresponding author: mosaly@aast.edu

Abstract. Our paper introduces a new technique for diagnosis of various heart diseases
without the need of highly experts to investigate the electrocardiogram (ECG). Using
the same electrodes of the ECG machine, it will be able to transmit directly the electrical
activity inside the heart to a moving picture. Our technique is based on artificial
intelligence algorithm using artificial neural networks (ANN). Finding the trans-
membrane potential (TMP) inside the heart from the body surface potential (BSP) is
known as the inverse problem of ECG. To have a unique solution for the inverse
problem the data used should be obtained from a forward model. A three dimensional
(3-D) model of cellular activation whole heart embedded in torso is simulated and
solved using COMSOL Multiphysics software. In our previous paper, one ANN
succeeded in displaying the wave propagation on the surface of a normal heart. In this
paper, we used a configuration of ANNs to display different cases of heart with
myocardial infarction (MI). To check the system accuracy, eight MI cases with different
sizes and locations in the heart are simulated in the forward model. This configuration
proved to be highly accurate in displaying each MI case -size and location- presenting
the infarction as an area with no electrical activity.

Keywords: Myocardial infarction, Electrocardiography, Inverse problem, Artificial neural network,

Depolarization pattern.

1. Introduction
The MI results from death of the heart muscle due to the blockage in the coronary artery. However, the
localization of MI mainly depends on the visual analysis of ECG [1-3], which strongly depends on the
physician experience. Therefore, it is very important to find a reliable method to visualize MIs directly
inside the heart. Reconstruction of MI by solving the inverse problem of ECG is a non-invasive and
relative low cost method to localize MI accurately. Recently, many methods have been introduced for
improving the reconstruction quality of MI by solving the inverse problem of ECG using regularization
techniques [4-7].

The inverse problem of ECG, also called the cardiac electrical source imaging, is to reconstruct the
electrical activities in the heart (TMP) from multichannel ECG measured on the body surface (BSP) [4,
8-13]. Also it should be noted that the transfer function between the TMP and the BSP is in fact highly
nonlinear. Different papers used ANN to solve mathematical inverse problems [14-19].

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ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

Most of the work done to detect and localize MI uses the visual analysis of ECG [1-3]. Other studies
reconstruct the MI by solving the inverse problem of ECG using regularization techniques [4-6]. Most
of these work focuses only on localizing the MI size and position in the heart. In our previous work, we
used one ANN to reconstruct the depolarization pattern for normal heart and for one MI case [20]. But,
with the increase in number of MI cases, the localization performance of an ANN classifier goes poor.

This paper focuses on visualizing the electrical activity inside the heart as a real time moving picture
during the depolarization period of 100ms for normal heart and different cases of MIs. In this paper, we
used two cascaded stages of ANNs to solve the inverse problem of ECG by reconstructing the
depolarization pattern (TMP) for different MI cases. Each case could be localized in the heart with its
accurate size in a minimal processing time. To check the system accuracy, eight MI cases of different
sizes and at various sites in the ventricles are simulated as eight different forward problems. Each case
was simulated by real heart equations (FitzHugh-Nagumo equations) using COMSOL Multiphysics
finite element software [9-11]. For the learning process of ANNs, TMP is computed for 74 different
positions covering the whole heart; BSP is computed for 9×9 array of electrodes placed on the torso
surface opposite to the heart. ANN is trained by the TMP and the BSP values computed all over the
depolarization period of 100 ms within the cardiac cycle. For the new configuration of two cascaded
stages of ANNs, the primary ANN is responsible for selecting the MI case and localizing the infarction
position and size in the heart. However, the secondary ANN is responsible for reconstructing the
depolarization pattern for the selected MI case. This configuration is also examined by two small
partially overlapped MI regions which are difficult to be detected and localized.

The rest of this paper is classified as shown. Section 2 illustrates the forward and inverse models used
in details including the heart model and the new proposed configuration of ANNs. The simulation results
of the forward and the inverse methods are displayed and discussed in section 3. Section 4 is devoted to
the main conclusions.

2. Model analysis

2.1 Forward model

The forward problem is based on simulating a heart-torso model with real heart equations using
COMSOL Multiphysics finite element software. The heart is divided into seven subdomains, each
subdomain has different cardiac cell properties and conductivities [9].

The TMP is measured at 74 different positions covering the surface of the heart as shown in Figure 1(a).
The BSP is measured at 81 different positions distributed as 9×9 array on the torso surface opposing the
heart as shown in Figure 1 (b). These values are measured 100 successive times for a depolarization
period of 100 ms.

(a) (b)
Figure 1. (a) The 74 TMP positions distributed on the heart surface and (b) the 81 (9×9) BSP positions
on the torso surface.

2
ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

In this study eight different MI cases are simulated in the forward model and reconstructed in the inverse
model. For each MI case a new forward model is simulated with a different infarcted region of different
size and location in the ventricles. Figure 2 shows three different MI cases, the infarction in each case is
indicated by an area with no activation presented in blue color. Figure 2(a) illustrates the infarction
location in the heart in the XY plan; the infarction size is represented in Figure2(b). To check our system
accuracy for more difficult MI cases, we simulated two smaller partially overlapped MI regions (the last
case shown in Figure 2). All infarctions are positioned spanning the epicardium, midmyocardium and
endocardium. For each MI case, the TMP is measured at the 74 positions covering the heart shown in
Figure1(a) and the BSP is measured at the 81 positions on the torso surface shown in Figure 1(b). For
each case the TMP and the BSP values are measured 100 successive times for a one complete
depolarization period.

(a) (b)
Figure 2. Three different MI cases, (a) The infarction location in the heart in the XY plan and (b)
represents the infarction size.

3
ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

2.2 Inverse problem solution using ANN

We used back propagation artificial neural network (traingdx algorithm).The TMP and the BSP values
measured in the forward model are used in the learning process of the ANNs.We used more than one
ANN to be able to detect severalMI cases and to visualize the cardiac electrical activity for each case
during the depolarization period. Our new configurationconsists of two cascaded stages of ANNsjoined
together bya MATLAB code.The model in this paper consists of a primary ANN and nine secondary
ANNs presented in Figure3.

Figure 3.The new configuration of two cascaded stages of ANNs block diagram.

The primary ANN is trainedby the TMP and the BSP values of the normal heart and all the MI cases
during the depolarization of the ventricles only. Its input is theBSP at a certain millisecond for one of
the nine heart cases shown in Figure3. The primary ANN role is to detect the heart case from the given
input according to the TMP and the BSP values learnt. The selection program activates the secondary
ANN according to the detected heart case. Each secondary ANN is trained by TMP and BSP for each
single heart case during one complete depolarization period. The output of the secondary ANN is the
TMP corresponding to the input BSP at a certain millisecond. For one complete depolarization period,
each input BSP from the outer surface electrodes gives an output of its corresponding TMP obtaining a
moving picture for the electrical activity inside the heart.

3. Results and discussion

3.1 Results of primary ANN
The primary ANN specifies the heart case according to the given input BSP. In Figure 4, three selected
MI cases are presented:(a) the left column is the forward model, while (b)the right column is the inverse
model, the axis of orientation is shown beside each case.

4
ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

FORWARD INVERSE

(a) (b)
Figure 4.Three selected MI cases (a) in the forward model, (b) in the inverse model.

3.2 Results of the secondary ANN

The secondary ANN reconstructs the depolarization pattern for each MI case. For each selected case the
TMP is reconstructed at each millisecond required according to the given input BSP and compared to
the original TMP from the forward model at this millisecond. Figure 5 showsthe depolarization pattern
for a MI case(Left ventricular) at four different milliseconds, Figure5(a) representsthe TMP in the
forward model andFigure5(b)represents the reconstructed TMPusing the new configuration.

5
ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

t= 1.258 s t= 1.287 s t= 1.321 s t=1.337 s

Forwar
d

(a)

Inverse

(b)

Figure 5.𝑉𝑚 (TMP) of the MI region 7 at four different milliseconds (a) in the forward method, (b) in
the inverse method of two cascaded stages of ANNs

The new proposed configuration of ANNs was examined for the eight different MI cases presented in
this paper. It succeeded toreconstruct the depolarization pattern for each case includingthe two smaller
partially overlapped cases.

4. Conclusion
Using two cascaded stages of ANNs shows a great success inreconstructing the depolarization pattern
fornormal heart and different MI cases from the BSPs computed in the forward model. The new
configuration gives an accurate estimation for the infarctions sizes and positions in the heart for eight
MI case, including difficult cases,with almost zero error compared to the forward equivalent constructed
cases.Furthermore, this technique can dispense with the complicated investigation of ECGgiving
directly a complete image of the electrical activity inside the heart during the depolarization period.

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ICaTAS 2021 IOP Publishing
Journal of Physics: Conference Series 2128 (2021) 012016 doi:10.1088/1742-6596/2128/1/012016

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