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Proceedings Paper

Modeling the influence of the VV delay for CRT on the electrical activation patterns in absence of conduction through the AV node
Author(s): D. A. Romero; Rafael Sebastián; Gernot Plank; Edward J. Vigmond; Alejandro F. Frangi
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Paper Abstract

From epidemiological studies, it has been shown that 0.2% of men and 0.1% of women suffer from a degree of atrioventricular (AV) block. In recent years, the palliative treatment for third degree AV block has included Cardiac Resynchronization Therapy (CRT). It was found that patients show more clinical improvement in the long term with CRT compared with single chamber devices. Still, an important group of patients does not improve their hemodynamic function as much as could be expected. A better understanding of the basis for optimizing the devices settings (among which the VV delay) will help to increase the number of responders. In this work, a finite element model of the left and right ventricles was generated using an atlas-based approach for their segmentation, which includes fiber orientation. The electrical activity was simulated with the electrophysiological solver CARP, using the Ten Tusscher et al. ionic model for the myocardium, and the DiFrancesco-Noble for Purkinje fibers. The model is representative of a patient without dilated or ischemic cardiomyopathy. The simulation results were analyzed for total activation times and latest activated regions at different VV delays and pre-activations (RV pre-activated, LV pre-activated). To optimize the solution, simulations are compared against the His-Purkinje network activation (normal physiological conduction), and interventricular septum activation (as collision point for the two wave fronts). The results were analyzed using Pearson's coefficient of correlation for point to point comparisons between simulation cases. The results of this study contribute to gain insight on the VV delay and how its adjustment might influence response to CRT and how it can be used to optimize the treatment.

Paper Details

Date Published: 17 March 2008
PDF: 9 pages
Proc. SPIE 6918, Medical Imaging 2008: Visualization, Image-Guided Procedures, and Modeling, 69182G (17 March 2008);
Show Author Affiliations
D. A. Romero, Univ. Pompeu Fabra (Spain)
Rafael Sebastián, Univ. Pompeu Fabra (Spain)
Gernot Plank, Johns Hopkins Univ. (United States)
Edward J. Vigmond, Univ. of Calgary (Canada)
Alejandro F. Frangi, Univ. Pompeu Fabra (Spain)

Published in SPIE Proceedings Vol. 6918:
Medical Imaging 2008: Visualization, Image-Guided Procedures, and Modeling
Michael I. Miga; Kevin Robert Cleary, Editor(s)

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