Abstract:

Modelling the interaction of the heart and the vascular system allows to study the pumping efficiency of the heart in a controlled environment under various cardiac and vascular conditions such as arrhythmias, dyssynchronies, regions of stiffened myocardium, valvular stenoses or decreased vascular compliances. To pose realistic hemodynamic boundary conditions to a four-chambered elastomechanical heart model, we developed a lumped element model of the closed loop human vascular system. Systemic and pulmonary circulations were each represented by a three-element Windkessel model emptying into a venous compliance. Both circulations were coupled by connecting the venous compliances to the corresponding atrium via venous resistances. Cardiac valves were represented by ideal diodes and resistances. Strong coupling between the heart and the vascular system model was accomplished by estimating the cardiac pressures that lead to continuous flows across the model interfaces. Active regulatory mechanisms were not considered. Pressures, flows and volumes throughout the circulatory system were simulated until a steady state was reached and the effects of model parameters on these hemodynamic parameters were evaluated in a sensitivity analysis. Increasing the systemic peripheral resistance by 50% caused an 8% decrease in stroke volume (SV) and a 33% increase in mean arterial pressure. Increased venous resistance descreased the E/A wave ratio of the atrioventricular flow and led to a reduced SV by impeding passive cardiac filling. Increasing the arterial compliance decreased mean cardiac pressures, while only slightly reducing the SV. Larger arterial resistances mainly caused higher peak systolic pressures. Furthermore, we show that embedding the heart model into surrounding elastic tissue by forcing permanent contact at the pericardial surface leads to more realistic time courses of atrial volumes and atrial pressure-volume curves composed of an A and a V loop as found in measurements. In conclusion, this work enables simulations of diseases that involve significant cardiovascular interaction.

Abstract:

Electrocardiographic imaging (ECGI) could help in diagnosis and treatment of atrial fibrillation (AF), the most common life-threatening arrhythmia. Based on a previous work by Figuera et al. on the reconstruction of epicardial potentials (EP) during AF, we explore the performance of a Tikhonov regularization with two spatial constraints for transmembrane voltage (TMV) based ECGI. We develop a new method to impose epi-endocardial similarity and show its benefit for ECGI of atrial activity. Apart from TMVs, local activation times and dominant frequency are evaluated as target parameters. In the AF models studied, joint reconstruction of epi- and endocardial TMVs showed performance comparable to the previously reported EPs imaging.