Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study

Heart failure leads to gross cardiac structural changes. While cardiac resynchronization therapy (CRT) is a recognized treatment for restoring synchronous activation, it is not clear how changes in cardiac shape and size affect the electrical pacing therapy. This study used a human heart computer mo...

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Detalles Bibliográficos
Autores: Romero García, Daniel, Sebastián Aguilar, Rafael, 1978-, Bijnens, Bart, Zimmerman, Viviana, Boyle, Patrick M., Vigmond, Edward J., Frangi Caregnato, Alejandro
Tipo de recurso: artículo
Estado:Versión aceptada para publicación
Fecha de publicación:2010
País:España
Institución:Universitat Pompeu Fabra
Repositorio:Repositorio Digital de la UPF
OAI Identifier:oai:repositori.upf.edu:10230/47699
Acceso en línea:http://hdl.handle.net/10230/47699
http://dx.doi.org/10.1007/s10439-010-9926-4
Access Level:acceso abierto
Palabra clave:Cardiac geometry
Electrophysiology
Purkinje system
Heart modeling
Cardiac resynchronization therapy
Ventricular pacing
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spelling Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model studyRomero García, DanielSebastián Aguilar, Rafael, 1978-Bijnens, BartZimmerman, VivianaBoyle, Patrick M.Vigmond, Edward J.Frangi Caregnato, AlejandroCardiac geometryElectrophysiologyPurkinje systemHeart modelingCardiac resynchronization therapyVentricular pacingHeart failure leads to gross cardiac structural changes. While cardiac resynchronization therapy (CRT) is a recognized treatment for restoring synchronous activation, it is not clear how changes in cardiac shape and size affect the electrical pacing therapy. This study used a human heart computer model which incorporated anatomical structures such as myofiber orientation and a Purkinje system (PS) to study how pacing affected failing hearts. The PS was modeled as a tree structure that reproduced its retrograde activation feature. In addition to a normal geometry, two cardiomyopathies were modeled: dilatation and hypertrophy. A biventricular pacing protocol was tested in the context of atrio-ventricular block. The contribution of the PS was examined by removing it, as well as by increasing endocardial conductivity. Results showed that retrograde conduction into the PS was a determining factor for achieving intraventricular synchrony. Omission of the PS led to an overestimate of the degree of electrical dyssynchrony while assessing CRT. The activation patterns for the three geometries showed local changes in the order of activation of the lateral wall in response to the same pacing strategy. These factors should be carefully considered when determining lead placement and optimizing device parameters in clinical practice.This research has been partially funded by the Industrial and Technological Development Center (CDTI) under the CENIT Programme (CDTEAM Project) and the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 224495 (euHeart Project). Dr. R. Sebastian was funded by the Ministerio de Ciencia e Innovacion (Juan de la Cierva program). Dr. B. Bijnens is an ICREA Research Professor at Universitat Pompeu Fabra. Dr. E. Vigmond and P. Boyle were funded by The Natural Sciences and Engineering Research Council of Canada. P. Boyle is supported by the Alberta Ingenuity Fund.Springer202120212010info:eu-repo/semantics/articleinfo:eu-repo/semantics/acceptedVersionapplication/pdfapplication/pdfhttp://hdl.handle.net/10230/47699http://dx.doi.org/10.1007/s10439-010-9926-4reponame:Repositorio Digital de la UPFinstname:Universitat Pompeu FabraInglésAnnals Biomedical Engineering. 2010;38(4):1388-98info:eu-repo/grantAgreement/EC/FP7/224495© Springer The final publication is available at Springer via http://dx.doi.org/10.1007/s10439-010-9926-4info:eu-repo/semantics/openAccessoai:repositori.upf.edu:10230/476992026-06-12T07:21:37Z
dc.title.none.fl_str_mv Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
title Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
spellingShingle Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
Romero García, Daniel
Cardiac geometry
Electrophysiology
Purkinje system
Heart modeling
Cardiac resynchronization therapy
Ventricular pacing
title_short Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
title_full Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
title_fullStr Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
title_full_unstemmed Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
title_sort Effects of the Purkinje system and cardiac geometry on biventricular pacing: a model study
dc.creator.none.fl_str_mv Romero García, Daniel
Sebastián Aguilar, Rafael, 1978-
Bijnens, Bart
Zimmerman, Viviana
Boyle, Patrick M.
Vigmond, Edward J.
Frangi Caregnato, Alejandro
author Romero García, Daniel
author_facet Romero García, Daniel
Sebastián Aguilar, Rafael, 1978-
Bijnens, Bart
Zimmerman, Viviana
Boyle, Patrick M.
Vigmond, Edward J.
Frangi Caregnato, Alejandro
author_role author
author2 Sebastián Aguilar, Rafael, 1978-
Bijnens, Bart
Zimmerman, Viviana
Boyle, Patrick M.
Vigmond, Edward J.
Frangi Caregnato, Alejandro
author2_role author
author
author
author
author
author
dc.subject.none.fl_str_mv Cardiac geometry
Electrophysiology
Purkinje system
Heart modeling
Cardiac resynchronization therapy
Ventricular pacing
topic Cardiac geometry
Electrophysiology
Purkinje system
Heart modeling
Cardiac resynchronization therapy
Ventricular pacing
description Heart failure leads to gross cardiac structural changes. While cardiac resynchronization therapy (CRT) is a recognized treatment for restoring synchronous activation, it is not clear how changes in cardiac shape and size affect the electrical pacing therapy. This study used a human heart computer model which incorporated anatomical structures such as myofiber orientation and a Purkinje system (PS) to study how pacing affected failing hearts. The PS was modeled as a tree structure that reproduced its retrograde activation feature. In addition to a normal geometry, two cardiomyopathies were modeled: dilatation and hypertrophy. A biventricular pacing protocol was tested in the context of atrio-ventricular block. The contribution of the PS was examined by removing it, as well as by increasing endocardial conductivity. Results showed that retrograde conduction into the PS was a determining factor for achieving intraventricular synchrony. Omission of the PS led to an overestimate of the degree of electrical dyssynchrony while assessing CRT. The activation patterns for the three geometries showed local changes in the order of activation of the lateral wall in response to the same pacing strategy. These factors should be carefully considered when determining lead placement and optimizing device parameters in clinical practice.
publishDate 2010
dc.date.none.fl_str_mv 2010
2021
2021
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/acceptedVersion
format article
status_str acceptedVersion
dc.identifier.none.fl_str_mv http://hdl.handle.net/10230/47699
http://dx.doi.org/10.1007/s10439-010-9926-4
url http://hdl.handle.net/10230/47699
http://dx.doi.org/10.1007/s10439-010-9926-4
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Annals Biomedical Engineering. 2010;38(4):1388-98
info:eu-repo/grantAgreement/EC/FP7/224495
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
application/pdf
dc.publisher.none.fl_str_mv Springer
publisher.none.fl_str_mv Springer
dc.source.none.fl_str_mv reponame:Repositorio Digital de la UPF
instname:Universitat Pompeu Fabra
instname_str Universitat Pompeu Fabra
reponame_str Repositorio Digital de la UPF
collection Repositorio Digital de la UPF
repository.name.fl_str_mv
repository.mail.fl_str_mv
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