Modeling Defibrillation of the Heart: Approaches and Insights

Abstract

Cardiac defibrillation, as accomplished nowadays by automatic, implantable devices (ICDs), constitutes the most important means of combating sudden cardiac death. While ICD therapy has proved to be efficient and reliable, defibrillation is a traumatic experience. Thus, research on defibrillation mechanisms, particularly aimed at lowering defibrillation voltage, remains an important topic. Advancing our understanding towards a full appreciation of the mechanisms by which a shock interacts with the heart is the most promising approach to achieve this goal. The aim of this paper is to assess the current state-of-the-art in ventricular defibrillation modeling, focusing on both numerical modeling approaches and major insights that have been obtained using defibrillation models, primarily those of realistic ventricular geometry. The paper showcases the contributions that modeling and simulation have made to our understanding of the defibrillation process. The review thus provides an example of biophysically based computational modeling of the heart (i.e., cardiac defibrillation) that has advanced the understanding of cardiac electrophysiological interaction at the organ level and has the potential to contribute to the betterment of the clinical practice of defibrillation.

Shock-induced termination of reentrant cardiac arrhythmias: Comparing monophasic and biphasic shock protocols

“…Many other theoretical and numerical efforts have been directed towards improving defibrillation protocols. [10][11][12] The recent paper by Trayanova et al 13 reviews the advances that have been provided by numerical modeling approaches. This paper highlights the importance of the virtual electrode phenomenon (VEP), which describes generation of action potentials in cardiac tissue (generally far from the actual electrodes).…”

BeatBox—HPC simulation environment for biophysically and anatomically realistic cardiac electrophysiology

“…. v1, which makes exactly two values: layer 0 (u-field) and layer 1 (v-field) values at the point of the grid with integer coordinates (10,20).…”

Anti-arrhythmic strategies for atrial fibrillation

“…Biophysical modeling and simulation strategies have long been used to understand electrical cardioversion and have been reviewed elsewhere (Trayanova et al 2011; Trayanova & Rantner 2014), and in more recent years used to evaluate ablative therapies (Guillem et al 2016; Jacquemet 2016). Here, we offer an overview of how computational modeling has contributed to the research pipeline and new mechanistic insight, as well as novel and improved diagnostics and therapeutics (Fig.…”