Rapid prediction of cardiac activation in the left ventricle with geometric deep learning: a step towards cardiac resynchronization therapy planning

Cardiac resynchronization therapy (CRT) is a common intervention for patients with dyssynchronous heart failure, yet approximately one-third of recipients fail to respond, partly due to suboptimal lead placement. Identifying optimal pacing sites remains challenging, largely due to patient-specific anatomical variability and limitations of current individualized planning strategies. In a step toward an in-silico approach, we develop two geometric deep learning models, based on graph neural network (GNN) and geometry-informed neural operator (GINO), to predict activation time maps on left ventricular (LV) geometries in real time. Trained on a large dataset generated from finite-element simulations spanning a wide range of synthetic LV shapes, pacing site configurations, and tissue conductivities, the GINO model outperforms the GNN on synthetic cases (1.38% vs 2.44% error), while both demonstrate comparable performance on real-world LV geometries (GINO: 4.79% vs GNN: 4.07%). Using the trained models, we develop a workflow to identify an optimal pacing site on the LV from a given activation time map and show that both models can robustly recover ground-truth subject-specific parameters from noisy inputs. In conjunction with an interactive web-based interface ( https://dcsim.egr.msu.edu/ ), this study shows potential and motivates future extension toward a clinical decision-support tool for personalized pre-procedural CRT optimization.