Modeling the different sections of the cardiac conduction system to obtain realistic electrocardiograms

Dux-Santoy, Lydia; Sebastián, Ramón Alonso; Rodrı́guez, José F.; Ferrero, J.M.

doi:10.1109/embc.2013.6611130

Cited by 5 publications

(6 citation statements)

References 23 publications

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“…This anatomical observation is further supported by the fact that septal depolarization happens from left to right (Dubin, 1996; Durrer et al, 1970). We defined a right bundle branch, a left anterior fascicle, and a left posterior fascicle (Keller et al, 2009; Dux-Santoy et al, 2013). The end nodes of these three structures mark the initial nodes to grow the Purkinje network.…”

Section: Methodsmentioning

confidence: 99%

Generating Purkinje networks in the human heart

Costabal

Hurtado

Kuhl

2016

Journal of Biomechanics

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The Purkinje network is an integral part of the excitation system in the human heart. Yet, to date, there is no in vivo imaging technique to accurately reconstruct its geometry and structure. Computational modeling of the Purkinje network is increasingly recognized as an alternative strategy to visualize, simulate, and understand the role of the Purkinje system. However, most computational models either have to be generated manually, or fail to smoothly cover the irregular surfaces inside the left and right ventricles. Here we present a new algorithm to reliably create robust Purkinje networks within the human heart. We made the source code of this algorithm freely available online. Using Monte Carlo simulations, we demonstrate that the fractal tree algorithm with our new projection method generates denser and more compact Purkinje networks than previous approaches on irregular surfaces. Under similar conditions, our algorithm generates a network with 1219 ± 61 branches, three times more than a conventional algorithm with 419 ± 107 branches. With a coverage of 11 ± 3 mm, the surface density of our new Purkije network is twice as dense as the conventional network with 22 ± 7 mm. To demonstrate the importance of a dense Purkinje network in cardiac electrophysiology, we simulated three cases of excitation: with our new Purkinje network, with left-sided Purkinje network, and without Purkinje network. Simulations with our new Purkinje network predicted more realistic activation sequences and activation times than simulations without. Six-lead electrocardiograms of the three case studies agreed with the clinical electrocardiograms under physiological conditions, under pathological conditions of right bundle branch block, and under pathological conditions of trifascicular block. Taken together, our results underpin the importance of the Purkinje network in realistic human heart simulations. Human heart modeling has the potential to support the design of personalized strategies for single- or bi-ventricular pacing, radiofrequency ablation, and cardiac defibrillation with the common goal to restore a normal heart rhythm.

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Section: Methodsmentioning

confidence: 99%

Generating Purkinje networks in the human heart

Costabal

Hurtado

Kuhl

2016

Journal of Biomechanics

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“…This calibration yielded a CV of 0.61 m/s along the fiber direction and of 0.29 m/s perpendicular to the fiber direction, in accordance with experimental measurements in human ventricles [48]. For the HPS, the CV was adjusted to 2.5 m/s approximately [47], [256].…”

Section: Methodssupporting

confidence: 79%

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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“…The diffusion coefficient in the conduction system was set to 0.0068 cm 2 /ms. In the Purkinje-myocardial junctions (PMJ), the diffusion coefficient was 0.0013 cm 2 /ms and we incorporated a transition stage between each PMJ and the endocardium [8]. Simulations were performed using the software ELEC-TRA implementing the Finite Element Method, used in this study to solve the monodomain model of electrical propagation in cardiac tissue [9].…”

Section: Methodsmentioning

confidence: 99%

Changes in QRS and T-wave Loops Subsequent to an Increase in Left Ventricle Globularity as in Intrauterine Growth Restriction: a Simulation Study

Bueno-Palomeque

Mountris

Mincholé

et al. 2020

2020 Computing in Cardiology Conference (CinC)

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Cardiovascular remodeling induced by intrauterine growth restriction manifests in adulthood by more globular ventricles, as evidenced by in vivo measurements. The angle between the dominant vectors of the QRS and T-wave loops has been reported to be significantly altered as a result of the induced remodeling. To investigate whether the more globular ventricular shape was a major factor contributing to such alteration, we performed electrophysiological simulations in a human biventricular model for control and in a model obtained by deforming the control one to represent a more spherical left ventricle (SLV). Transmural ventricular heterogeneities and a Purkinje network were included. 12-lead ECGs were calculated, from which spatial QRS and T-wave angles were computed. The angle between the T-wave and the XZ-plane was found to increase in the SLV model, showing a variation similar to that reported in in vivo studies. However, the angle between the dominant vectors of the QRS and T-wave loops projected onto the XY-plane was lower for control, contrary to clinical observations in IUGR adults. Other clinical results could not be reproduced in our simulations either. Our findings suggest that a more globular left ventricular shape leads to changes in the angles of QRS and T-wave loops, but further research is needed to fully understand these changes and the underlying mechanisms.

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Modeling the different sections of the cardiac conduction system to obtain realistic electrocardiograms

Cited by 5 publications

References 23 publications

Generating Purkinje networks in the human heart

Generating Purkinje networks in the human heart

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

Changes in QRS and T-wave Loops Subsequent to an Increase in Left Ventricle Globularity as in Intrauterine Growth Restriction: a Simulation Study

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