A rule-based method for predicting the electrical activation of the heart with cardiac resynchronization therapy from non-invasive clinical data

A. W. C. Lee*, U. C. Nguyen, O. Razeghi, J. Gould, B. S. Sidhu, B. Sieniewicz, J. Behar, M. Mafi-Rad, G. Plank, F. W. Prinzen, C. A. Rinaldi, K. Vernooy, S. Niederer

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

16 Citations (Web of Science)

Abstract

Background: Cardiac Resynchronization Therapy (CRT) is one of the few effective treatments for heart failure patients with ventricular dyssynchrony. The pacing location of the left ventricle is indicated as a determinant of CRT outcome.

Objective: Patient specific computational models allow the activation pattern following CRT implant to be predicted and this may be used to optimize CRT lead placement.

Methods: In this study, the effects of heterogeneous cardiac substrate (scar, fast endocardial conduction, slow septal conduction, functional block) on accurately predicting the electrical activation of the LV epicardium were tested to determine the minimal detail required to create a rule based model of cardiac electrophysiology. Non-invasive clinical data (CT or CMR images and 12 lead ECG) from eighteen patients from two centers were used to investigate the models.

Results: Validation with invasive electro-anatomical mapping data identified that computer models with fast endocardial conduction were able to predict the electrical activation with a mean distance errors of 9.2 +/- 0.5 mm (CMR data) or (CT data) 7.5 +/- 0.7 mm.

Conclusion: This study identified a simple rule-based fast endocardial conduction model, built using non-invasive clinical data that can be used to rapidly and robustly predict the electrical activation of the heart. Pre-procedural prediction of the latest electrically activating region to identify the optimal LV pacing site could potentially be a useful clinical planning tool for CRT procedures. (C) 2019 The Authors. Published by Elsevier B.V.

Original languageEnglish
Pages (from-to)197-213
Number of pages17
JournalMedical Image Analysis
Volume57
DOIs
Publication statusPublished - Oct 2019

Keywords

  • Cardiac resynchronization therapy
  • Electrophysiology
  • Computational models
  • Patient-specific simulations
  • VENTRICULAR LEAD PLACEMENT
  • DIFFUSION TENSOR MRI
  • CONDUCTION-VELOCITY
  • FIBER ARCHITECTURE
  • HISTOLOGICAL VALIDATION
  • TRABECULAR MUSCLE
  • QRS DURATION
  • PACING SITE
  • OPTIMIZATION
  • MODEL

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