Concurrent optimization of timing delays and electrode positioning in biventricular pacing based on a computer heart model assuming 17 left ventricular segments

Miri, R.; Reumann, Matthias; Farina, D.; Dössel, Olaf

doi:10.1515/bmt.2009.013

Cited by 7 publications

(7 citation statements)

References 24 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%

“…A different criterion suggested in the literature is to place the LV lead in the site corresponding to the shortest QRS registered. Nevertheless, simulation studies that apply this last non-invasive criterion (Miri et al, 2009a,b) estimated QRSd through calculation of the total ventricular activation time (TAT), a parameter not easily accessible in clinical or even experimental settings. In addition, studies such as Potse et al (2012) have observed that biventricular pacing did not change QRS duration but reduced total ventricular activation time when the stimulation was applied in one point of the LV free wall.…”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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“…The third category considers cardiac output estimated by Swan-Ganz catheterization, thoracic impedance, ultrasonography, and other techniques [55,57,58,[64][65][66][67][68][69][70]. The fourth category eliminates individual optimization and uses a standard value because these methods acknowledge no major differences in VV delay settings [3,35,[71][72][73][74][75][76][77][78][79][80][81][82].…”

Section: Categorization Of Vv Delay Optimization Methodsmentioning

confidence: 99%

Ventriculoventricular delay optimization of a cardiac resynchronization device

Sagara

2014

Journal of Arrhythmia

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Cardiac resynchronization therapy (CRT) has become a standard option for patients with severe low cardiac function and mild to severe heart failure. However, its potential has not been maximized to date, as the optimal atrioventricular delay, ventriculoventricular (VV) delay, and tachy therapy settings remain unknown. Here, data from various studies have been used to estimate several CRT settings. Three search words—interventricular interval, VV delay, and interventricular delay with cardiac resynchronization therapy—were entered into PubMed. The methods used to optimize VV delay included ultrasonography, radioisotope diagnosis, scintigraphy, electrocardiography, Swan–Ganz catheterization, and thoracic impedance. Their populations and results were analyzed to identify convincing rules. Methods for VV delay optimization in the literature can be categorized into four patterns. Time and cost were high in several categories. Most studies concluded that their method was effective but no small amount of papers denied individual detailed optimization. There were some population biases in most papers. Individual optimization had a major impact in patients with ischemic heart disease but no significant impact in patients with non‐ischemic heart diseases. In summary, CRT is an established therapy, but a well‐controlled study is required to find conclusive methods for VV delay optimization.

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“…With a similar goal, cellular automaton models [ 69 ] have also been employed in recent CRT studies [ 70 – 73 ]. In this model, instead of explicitly solving the complex current flow interaction between the intracellular and extracellular domains, action potentials are pre-calculated based on ionic current equations.…”

Section: Electrophysiology Modelsmentioning

confidence: 99%

“…These models offer the opportunity to carry out non-invasive, automatic optimization of CRT in silico. Briefly, the approach consists of simulating electrical activation in a realistic BiV anatomy for different AVD and VVD as well as several different lead locations and minimizing the error between the obtained activation sequences for each case against a simulated physiological case to determine which combination of AVD, VVD, and lead location yields the best acute response to CRT [ 70 – 73 , 81 ]. Such models have demonstrated that patient-specific optimization of lead location and AVD and VVD can improve CRT efficacy and impact treatment success [ 31 , 70 , 73 ] and that the use of body surface potential maps can further improve in-silico CRT optimization [ 82 ].…”

Section: Electrophysiology Modelsmentioning

confidence: 99%

Computational Modeling for Cardiac Resynchronization Therapy

Lee

Costa

Strocchi

et al. 2018

J. of Cardiovasc. Trans. Res.

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Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) patients with an electrical substrate pathology causing ventricular dyssynchrony. However 40–50% of patients do not respond to treatment. Cardiac modeling of the electrophysiology, electromechanics, and hemodynamics of the heart has been used to study mechanisms behind HF pathology and CRT response. Recently, multi-scale dyssynchronous HF models have been used to study optimal device settings and optimal lead locations, investigate the underlying cardiac pathophysiology, as well as investigate emerging technologies proposed to treat cardiac dyssynchrony. However the breadth of patient and experimental data required to create and parameterize these models and the computational resources required currently limits the use of these models to small patient numbers. In the future, once these technical challenges are overcome, biophysically based models of the heart have the potential to become a clinical tool to aid in the diagnosis and treatment of HF.

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Concurrent optimization of timing delays and electrode positioning in biventricular pacing based on a computer heart model assuming 17 left ventricular segments

Abstract: This work proposes a novel non-invasive optimization algorithm to find the best electrode positioning sites and timing delays for BVP in patients with LBBB and MI. This algorithm can be used to plan an optimal therapy for an individual patient.

Cited by 7 publications

References 24 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

Ventriculoventricular delay optimization of a cardiac resynchronization device

Computational Modeling for Cardiac Resynchronization Therapy

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