Miri R, Dössel O
Institute of Biomedical Engineering, Universität Karlsruhe (TH), Kaiserstrasse 12, 76131 Karlsruhe, Germany.
Annu Int Conf IEEE Eng Med Biol Soc. 2009;2009:2815-8. doi: 10.1109/IEMBS.2009.5333571.
An improvement of biventricular pacing (BVP) could be possible by detecting the patient specific optimal pacemaker parameters. Body surface potential map (BSPM) is used to obtain the electrophysiology and pathology of an individual patient non-invasively. The clinical measurements of BSPM are used to parameterize the computer model of the heart to represent the individual pathology. The computer model of the heart is used to simulate the dyssynchrony of the ventricles and myocardial infarction (MI). Cardiac electrophysiology is simulated with ten Tusscher cell model, while excitation propagation is intended with adaptive cellular automaton at physiological and pathological conduction stages. The optimal electrode configurations are identified by minimizing the QRS duration error of healthy and pathology case with/without pacing between pre and post-implantation. Afterwards, the simulated ECGs for optimal pacing are compared to the post implantation clinically measured ECGs. The optimal electrode positions found by simulation are comparable to the ones meausured in hospital. The QRS duration reduction error between measured and simulated 12 ECG signals are similar with a constant offset of 15 ms. The personalized model present in this research is an effective tool for therapy planning of BVP in patients with congestive heart failure.
通过检测患者特定的最佳起搏器参数，双心室起搏（BVP）或许能够得到改进。体表电位图（BSPM）用于无创获取个体患者的电生理学和病理学信息。BSPM的临床测量结果用于对心脏计算机模型进行参数化，以呈现个体病理学特征。心脏计算机模型用于模拟心室不同步和心肌梗死（MI）。使用十个Tusscher细胞模型模拟心脏电生理学，同时在生理和病理传导阶段用自适应细胞自动机模拟兴奋传播。通过在植入前后对健康和病理病例在有/无起搏情况下使QRS波时限误差最小化来确定最佳电极配置。之后，将模拟的最佳起搏心电图与植入后临床测量的心电图进行比较。模拟找到的最佳电极位置与医院测量的位置相当。测量和模拟的12导联心电图信号之间的QRS波时限缩短误差相似，恒定偏移为15毫秒。本研究中提出的个性化模型是用于充血性心力衰竭患者BVP治疗规划的有效工具。
