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Effects of the Purkinje System and Cardiac Geometry on Biventricular Pacing: A Model Study

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Abstract

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Computational Imaging & Simulation Technologies in Biomedicine (CISTIB), Universitat Pompeu Fabra, Carrer Tanger, 122–140 (Office N 55,123), 08018, Barcelona, Spain

    Daniel Romero, Rafael Sebastian, Bart H. Bijnens, Viviana Zimmerman & Alejandro F. Frangi

  2. Networking Biomedical Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Barcelona, Spain

    Daniel Romero, Rafael Sebastian, Bart H. Bijnens, Viviana Zimmerman & Alejandro F. Frangi

  3. Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain

    Bart H. Bijnens & Alejandro F. Frangi

  4. Department of Electrical and Computer Engineering, University of Calgary, Calgary, AB, T2N 1N4, Canada

    Patrick M. Boyle & Edward J. Vigmond

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  1. Daniel Romero
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  2. Rafael Sebastian
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Correspondence to Daniel Romero.

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Associate Editor Larry V. McIntire oversaw the review of this article.

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Romero, D., Sebastian, R., Bijnens, B.H. et al. Effects of the Purkinje System and Cardiac Geometry on Biventricular Pacing: A Model Study. Ann Biomed Eng 38, 1388–1398 (2010). https://doi.org/10.1007/s10439-010-9926-4

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