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Optimization of cardiac resynchronization therapy based on a cardiac electromechanics-perfusion computational model. Comput Biol Med 2022 Feb;141:105050

Date

11/27/2021

Pubmed ID

34823858

Pubmed Central ID

PMC8810745

DOI

10.1016/j.compbiomed.2021.105050

Scopus ID

2-s2.0-85119687899   2 Citations

Abstract

Cardiac resynchronization therapy (CRT) is an established treatment for left bundle branch block (LBBB) resulting in mechanical dyssynchrony. Approximately 1/3 of patients with CRT, however, are non-responders. To understand factors affecting CRT response, an electromechanics-perfusion computational model based on animal-specific left ventricular (LV) geometry and coronary vascular networks located in the septum and LV free wall is developed. The model considers contractility-flow and preload-activation time relationships, and is calibrated to simultaneously match the experimental measurements in terms of the LV pressure, volume waveforms and total coronary flow in the left anterior descending and left circumflex territories from 2 swine models under right atrium and right ventricular pacing. The model is then applied to investigate the responses of CRT indexed by peak LV pressure and (dP/dt)max at multiple pacing sites with different degrees of perfusion in the LV free wall. Without the presence of ischemia, the model predicts that basal-lateral endocardial region is the optimal pacing site that can best improve (dP/dt)max by 20%, and is associated with the shortest activation time. In the presence of ischemia, a non-ischemic region becomes the optimal pacing site when coronary flow in the ischemic region fell below 30% of its original value. Pacing at the ischemic region produces little response at that perfusion level. The optimal pacing site is associated with one that optimizes the LV activation time. These findings suggest that CRT response is affected by both pacing site and coronary perfusion, which may have clinical implication in improving CRT responder rates.

Author List

Fan L, Choy JS, Raissi F, Kassab GS, Lee LC

Author

Lei Fan PhD Assistant Professor in the MU-MCW Department of Biomedical Engineering department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Animals
Bundle-Branch Block
Cardiac Resynchronization Therapy
Computer Simulation
Heart Failure
Heart Ventricles
Humans
Perfusion
Swine