Abstract:

In open heart surgery the patient is connected to a heart-lung machine which pumps and oxygenizes the blood. The body core temperature is reduced by cooling the blood in a heat exchanger to reduce oxygen consumption of the tissues and so protect organs from hypoxia. Monitoring of vital parameters is crucial for safety of the patient. However, only little information is available from direct measurement. Models of haemodynamics and heat exchange in the human body are presented in this paper which provide the perfusionist with detailed data on blood flow and temperature in regions of the body which cannot be accessed by measurement devices. Simulation is performed on a real-time hardware platform which receives measured signals from the heart-lung machine via a serial interface.

Abstract:

The human atria contain fine structures, which can hardly be distinguished with common medical imaging techniques. However, some of these structures play an important role in the electrophysiologic depolarisation sequence of the atria. We present a semi-automatic algorithm to segment the sinus node, Bachmann’s Bundle and the Terminal Crest in given anatomical shape models of the atria. The algorithm bases on anatomical knowledge of the atria and only requires the user to provide few distinct landmarks in the atria as input. Incorporation of these structures into patient individual atrial geometries augments the electrophysiological correctness of the models.

Abstract:

Atrial fibrillation (AF) is the most common cardiac arrhythmia in the western world. Genetic variants in the cardiac I Kr channel have been identified to influence ventricular repolarization. The aim of this work is to investigate the effect of the mutation N588K on atrial repolarization and the predisposition to AF. Experimental data of N588K mutated hERG channel were incorporated in an atrial ionic model using parameter fitting. The effects of the mutation were analyzed in cell and tissue. N588K showed a gain of function effect, causing a rapid repolarization and a shortening of the action potential duration. Computer simulations of a schematic right atrial geometry were used to investigate the excitation conduction properties. The effective refractory period of mutant cells were reduced from 317 to 233 ms at 1 Hz. The conduction velocity is not significantly influenced by the mutation. Nevertheless, the wavelength of mutant cells is for all frequencies smaller, indicating that the mutation N588K predisposes the initiation and perpetuation of AF.

Abstract:

Patient-specific cardiac simulations are approaching clinical applications. They could for example improve the treatment of atrial fibrillation (AF). Currently, many patients suffering from AF are treated with minimally-invasive catheter ablation. Using this technique, trigger sources for AF (mainly the pulmonary veins), are electrically isolated from the rest of the atrium. However, a large set of different ablation strategies is currently used in clinical practice. Therefore, the choice of a certain ablation strategy as well as the probability for successful and sustained AF termination are strongly dependent on the experience of the cardiologist. Atrial simulations could assist the cardiologist in the choice of a suitable method for an individual patient. For this, the atrial models have to be adapted to the patient. Besides anatomical modeling, several challenges must be faced in this process. First, an appropriate model of cellular electrophysiology and excitation conduction must be chosen. The model must provide the necessary accuracy and at the same time be fast enough for clinical applications. As a trade-off between accuracy and speed, we propose a minimal model adapted to atrial electrophysiology. Second, a main problem is the adaptation of physiological parameters in the patient-specific model as well as its validation. Therefore, an interface between clinical data and the model is needed. Data collected in standard clinical workflow are mainly intracardiac catheter ECGs. We therefore present techniques to model such catheter measurements. Signals from both circular mapping catheters (such as Lasso or Orbiter) as well as Coronary Sinus catheters can be simulated and compared to clinical signals. These are important steps towards clinical applications of atrial models. The long-term goal then is to assist the cardiologist in the choice of the best treatment for an individual patient.