R. Miri, O. Dössel, M. Reumann, D. Farina, and B. Osswald. Computer assisted optimization of biventricular pacing assuming ventricular heterogeneity. In 11th Mediterranean Conference on Medical and Biomedical Engineering and Computingand Computing, vol. 16(15) , pp. 541-544, 2007
Reduced cardiac output, dysfunction of the conduction system, atrio-ventricular block, bundle branch blocks and remodeling of the chambers are results of congestive heart failure (CHF). Biventricular pacing as Cardiac Resynchronization Therapy (CRT) is a recognized therapy for the treatment of heart failure. The present paper investigates an automated non-invasive strategy to optimize CRT with respect to electrode positioning and timing delays based on a complex threedimensional computer model of the human heart. The anatomical model chosen for this study was the segmented data set of the Visible Man and a set of patient data with dilated ventricles and left bundle branch block. The excitation propagation and intra-ventricular conduction were simulated with Ten Tusscher electrophysiological cell model and adaptive cellular automaton. The pathologies simulated were a total atrioventricular (AV) block and a left bundle branch block (LBBB) in conjunction with reduced interventricular conduction velocities. The simulated activation times of different myocytes in the healthy and diseased heart model are compared in terms of root mean square error. The outcomes of the investigation show that the positioning of the electrodes, with respect to proper timing delay influences the efficiency of the resynchronization therapy. The proposed method may assist the surgeon in therapy planning.
An optimal electrode position, atrio-ventricular (AV) and interventricular (VV) delay in cardiac resynchronization therapy (CRT) improves its success. An optimization strategy does not yet exist. A computer model of the Visible Man and a patient heart was used to simulate an atrio-ventricular and a left bundle branch block with 0%, 20% and 40% reduction in interventricular conduction velocity, respectively. The minimum error between physiological excitation and pathology/therapy was automatically computed for 12 different electrode positions. AV and VV delay timing was adjusted accordingly. The results show the importance of individually adjusting the electrode position as well as the timing delays to the patient's anatomy and pathology, which is in accordance with current clinical studies. The presented methods and strategy offer the opportunity to carry out non-invasive, automatic optimization of CRT preoperatively. The model is subject to validation in future clinical studies.
Conference Contributions (11)
D. Farina, and O. Dössel. Model-based approach to the localization of infarction. In Proc. Computers in Cardiology, vol. 34, pp. 173-176, 2007
A model-based approach to noninvasively determine the location and size of the infarction scar is proposed, that in addition helps to estimate the risk of arrhythmias. The approach is based on the optimization of an electrophysiological heart model with an introduced infarction scar to fit the multichannel ECG measured on the surface of the patient's thorax. This model delivers the distributions of transmembrane voltages (TMV) within the ventricles during a single heart cycle. The forward problem of electrocardiography is solved in order to obtain the simulated ECG of the patient. This ECG is compared with the measured one, the difference is used as the criterion for optimization of model parameters, which include the site and size of infarction scar.
A computer model of the human heart is presented, that starts with the electrophysiology of single myocardial cells including all relevant ion channels, spans the de- and repolarization of the heart including the generation of the Electrocardiogram (ECG) and ends with the contraction of the heart that can be measured using 4D Magnetic Resonance Imaging (MRI). The model can be used to better understand physiology and pathophysiology of the heart, to improve diagnostics of infarction and arrhythmia and to enable quantitative therapy planning. It can also be used as a regularization tool to gain better solutions of the ill-posed inverse problem of ECG. Movies of the evolution of electrophysiology of the heart can be reconstructed from Body Surface Potential Maps (BSPM) and MRI, leading to a new non-invasive medical imaging technique.
Y. Jiang, D. Farina, and O. Dössel. An improved spatio-temporal maximum a posteriori approach to solve the inverse problem of electrocardiography. In 41. Jahrestagung der DGBMT im VDE. Proceedings BMT 2007, vol. 52, 2007
Y. Jiang, D. Farina, and O. Dössel. Reconstruction of myocardial infarction using the improved spatio-temporal MAP-based regularization. In Proc. the 6th International Symposium on Noninvasive Functional Source Imaging of the Brain and Heart and the International Conference on Functional Biomedical Imaging, 2007
The congenital long-QT syndrome is commonly associated with a high risk for polymorphic ventricular tachy-cardia and sudden cardiac death. This is probably due to an intensification of the intrinsic heterogeneities present in ventricular myocardium. Increasing the electrophysiological heterogeneities amplifies the dispersion of repolarization which directly affects the morphology of the T wave in the ECG. The aim of this work is to investigate the effects of LQT2, a specific subtype of the long-QT syndrome (LQTS), on the Body Surface Potential Maps (BSPM) and the ECG. In this context a three-dimensional, heterogeneous model of the human ventricles is used to simulate both physiological and pathological excitation propagation. The results are used as input for the forward calculation of the BSPM and ECG. Characteristic QT prolongation is simulated correctly. The main goal of this study is to prepare and evaluate a simulation environment that can be used prospectivley to find features in the ECG or the BSPM that are characteristic for the LQTS. Such features might be used to facilitate the identification of LQTS patients.
R. Miri, O. Dössel, M. Reumann, D. Farina, and B. Osswald. Optimizing A-V and V-V delay in cardiac resynchronization therapy in simulations including ventricle heterogeneity. In 5th IASTED International Conference on Biomedical Engineering BioMED 2007, 2007
Congestive heart failure (CHF) is affecting more than 15 million people in the western population with an increasing number. Biventricular pacing as Cardiac Resynchronization Therapy (CRT) is a recognized therapy for the treatment of heart failure. The present paper investigates the optimal pacing sites and stimuli delays for stimulation, based on a complex three-dimensional computer model of the human heart. The anatomical features were derived from the Visible Man data set. The excitation propagation and intraventricular conduction were simulated with Ten Tusscher electrophysiological cell model and an adaptive cellular automaton. Biventricular pacing in AV block III and LBBB with different interventricular conduction delays were investigated. The simulated activation times of different myocytes in the healthy and diseased heart model are compared in terms of root mean square error (ERMS). The outcomes of the investigation underline that the positioning of the electrodes considering a proper atrioventricular and intraventricular delay influences the efficiency of the resynchronization therapy. The results of this optimization strategy may assist the surgeon in therapy planning.
R. Miri, O. Dössel, M. Reumann, D. U. J. Keller, and D. Farina. A non-invasive computer based optimization strategy of biventricular pacing. In Tagungsband 6. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e. V., pp. 133-136, 2007
R. Miri, O. Dössel, M. Reumann, D. Keller, and D. Farina. Computer based optimization of biventricular pacing according to the left ventricular 17 myocardial segments. In Proceedings of the 29th Annual International Conference of the IEEE EMBS, pp. 1418-1421, 2007
Heterogeneity of ion channel properties within human ventricular tissue determines the sequence of repolarization under healthy conditions. In this computational study, the impact of different extend of electrophysiological heterogeneity in both human ventricles on the ECG was investigated by a forward calculation of the cardiac electrical signals on the body surface. The gradients ranged from solely transmural, interventricular and apico-basal up to full combination of these variations. As long interventricular heterogeneities were neglected, the transmural gradient generated a positive T wave that was increased when apico-basal variations were considered. Inclusion of interventricular changes necessitated the incorporation of both transmural and apico-basal heterogeneities to reproduce the positive T wave.