Comparison of the electrophysiologically based optimization methods with different pacing parameters in patient undergoing resynchronization treatment

Miri, R.; Reumann, Matthias; Keller, D. U. J.; Farina, D.; Dössel, Olaf

doi:10.1109/iembs.2008.4649513

Cited by 8 publications

(3 citation statements)

References 9 publications

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“…Biophysical models of the heart have been used to optimize AVD, VVD and lead location during CRT simulation (Miri et al, 2008, 2009a,b; Pluijmert et al, 2016; Lee et al, 2017). QRSd, estimated as the difference between the time of the first and last activated cardiac cell (or TAT), have been used as one optimization criterion by Miri and coworkers.…”

Section: Discussionmentioning

confidence: 99%

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

et al. 2019

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Patients suffering from heart failure and left bundle branch block show electrical ventricular dyssynchrony causing an abnormal blood pumping. Cardiac resynchronization therapy (CRT) is recommended for these patients. Patients with positive therapy response normally present QRS shortening and an increased left ventricle (LV) ejection fraction. However, around one third do not respond favorably. Therefore, optimal location of pacing leads, timing delays between leads and/or choosing related biomarkers is crucial to achieve the best possible degree of ventricular synchrony during CRT application. In this study, computational modeling is used to predict the optimal location and delay of pacing leads to improve CRT response. We use a 3D electrophysiological computational model of the heart and torso to get insight into the changes in the activation patterns obtained when the heart is paced from different regions and for different atrioventricular and interventricular delays. The model represents a heart with left bundle branch block and heart failure, and allows a detailed and accurate analysis of the electrical changes observed simultaneously in the myocardium and in the QRS complex computed in the precordial leads. Computational simulations were performed using a modified version of the O'Hara et al. action potential model, the most recent mathematical model developed for human ventricular electrophysiology. The optimal location for the pacing leads was determined by QRS maximal reduction. Additionally, the influence of Purkinje system on CRT response was assessed and correlation analysis between several parameters of the QRS was made. Simulation results showed that the right ventricle (RV) upper septum near the outflow tract is an alternative location to the RV apical lead. Furthermore, LV endocardial pacing provided better results as compared to epicardial stimulation. Finally, the time to reach the 90% of the QRS area was a good predictor of the instant at which 90% of the ventricular tissue was activated. Thus, the time to reach the 90% of the QRS area is suggested as an additional index to assess CRT effectiveness to improve biventricular synchrony.

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Section: Discussionmentioning

confidence: 99%

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

et al. 2019

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“…2 The infarction was modeled by a spherical area of about 30 voxels volume including necrotic tissue with an excitation conduction velocity of zero in the center and a surrounding ischemic area with slower conduction velocity. 6,13,14,17 The LBBB was modeled with a disconnection in the excitation conduction system right behind the bundle of His in the left bundle. The simulated and measured 12 standard ECG channels are demonstrated in Fig.…”

Section: Clinical Measurements and The Pathological Modelingmentioning

confidence: 99%

Applicability of Body Surface Potential Map in Computerized Optimization of Biventricular Pacing

et al. 2010

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Biventricular pacing (BVP) could be improved by identifying the patient-specific optimal electrode positions. Body surface potential map (BSPM) is a non-invasive technique for obtaining the electrophysiology and pathology of a patient. The study proposes the use of BSPM as input for an automated non-invasive strategy based on a personalized computer model of the heart, to identify the patient pathology and specific optimal treatment with BVP devices. The anatomy of a patient suffering from left bundle branch block and myocardial infarction is extracted from a series of MR data sets. The clinical measurements of BSPM are used to parameterize the computer model of the heart to represent the individual pathology. Cardiac electrophysiology is simulated with ten Tusscher cell model and excitation propagation is calculated with adaptive cellular automaton, at physiological and pathological conduction levels. The optimal electrode configurations are identified by evaluating the QRS error between healthy and pathology case with/without pacing. Afterwards, the simulated ECGs for optimal pacing are compared to the post-implantation clinically measured ECGs. Both simulation and clinical optimization methods identified the right ventricular (RV) apex and the LV posterolateral regions as being the optimal electrode configuration for the patient. The QRS duration is reduced both in measured and simulated ECG after implantation with 20 and 14%, respectively. The optimized electrode positions found by simulation are comparable to the ones used in hospital. The similarity in QRS duration reduction between measured and simulated ECG signals indicates the success of the method. The computer model presented in this work is a suitable tool to investigate individual pathologies. The personalized model could assist therapy planning of BVP in patients with congestive heart failure. The proposed method could be used as prototype for further clinically oriented investigations of computerized optimization of biventricular pacing.

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“…Biophysical models of the heart have been used to optimize AVD, VVD and lead location during CRT simulation [136], [142]- [144], [210]. QRSd, estimated as the difference between the time of the first and last activated cardiac cell (or TAT), have been used as one optimization criterion by Miri and coworkers.…”

Section: Optimal Delay Between Pacing Leadsmentioning

confidence: 99%

Contribution to the improvement of electrical therapies and to the comprehension of electrophysiological mechanisms in heart failure and acute ischemia using computational simulation

Garay¹,

Fernando²

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A better understanding of the mechanisms underlying ventricular arrhythmias, as well as an improvement of the associated electrical and pharmacological therapies, are a key factor to prevent sudden cardiac death in patients with structural and electrical heart diseases. An important cardiomyopathy that can lead to life-threatening ventricular arrhythmias is heart failure (HF). Patients with HF also often suffer from left bundle branch block (LBBB), which worsens their condition. Currently, the most effective treatment to these patients is cardiac resynchronization therapy (CRT). However, many patients are non-responders, so further studies are needed to improve this treatment.

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Comparison of the electrophysiologically based optimization methods with different pacing parameters in patient undergoing resynchronization treatment

Cited by 8 publications

References 9 publications

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study

Applicability of Body Surface Potential Map in Computerized Optimization of Biventricular Pacing

Contribution to the improvement of electrical therapies and to the comprehension of electrophysiological mechanisms in heart failure and acute ischemia using computational simulation

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