Efficiency of Timing Delays and Electrode Positions in Optimization of Biventricular Pacing: A Simulation Study

Abstract

Electrode positions and timing delays influence the efficacy of biventricular pacing (BVP). Accordingly, this study focuses on BVP optimization, using a detailed 3-D electrophysiological model of the human heart, which is adapted to patient-specific anatomy and pathophysiology. The research is effectuated on ten heart models with left bundle branch block and myocardial infarction derived from magnetic resonance and computed tomography data. Cardiac electrical activity is simulated with the ten Tusscher cell model and adaptive cellular automaton at physiological and pathological conduction levels. The optimization methods are based on a comparison between the electrical response of the healthy and diseased heart models, measured in terms of root mean square error (E(RMS)) of the excitation front and the QRS duration error (E(QRS)). Intra- and intermethod associations of the pacing electrodes and timing delays variables were analyzed with statistical methods, i.e., t -test for dependent data, one-way analysis of variance for electrode pairs, and Pearson model for equivalent parameters from the two optimization methods. The results indicate that lateral the left ventricle and the upper or middle septal area are frequently (60% of cases) the optimal positions of the left and right electrodes, respectively. Statistical analysis proves that the two optimization methods are in good agreement. In conclusion, a noninvasive preoperative BVP optimization strategy based on computer simulations can be used to identify the most beneficial patient-specific electrode configuration and timing delays.

The Left and Right Ventricles Respond Differently to Variation of Pacing Delays in Cardiac Resynchronization Therapy: A Combined Experimental- Computational Approach

“…For example, in a cohort of 648 virtual patients it was found that the location of the LV pacing site is an important factor in response to CRT (Crozier et al, 2016). Electrophysical cardiac computer modeling studies also demonstrated the importance of LV pacing site and the potential of simulations to predict the electrical optimal pacing location and setting (Reumann et al, 2007; Miri et al, 2009; Niederer et al, 2011). Our study shows, however, that an electrical optimum (lowest electrical dyssynchrony) might not necessarily be optimal for overall pump function.…”

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

“…12 The originality of this article lies within the inclusion of BSPM in the optimization method. Several studies tested BSPM accuracy and indicated that the estimate of the infarct location depends on the AHA subdivision.…”

Mathematical Modeling and Simulation of Ventricular Activation Sequences: Implications for Cardiac Resynchronization Therapy

“…For example, Miri et al. [65, 87] computed biventricular-paced activation sequences and ECGs in ten patient-specific heart models to simulate the process of CRT tuning. They found that in addition to AV and VV delays, the position of the LV electrode influenced electrical synchrony and that the optimal position was patient-dependent.…”