Okada Jun-Ichi, Sasaki Teruyoshi, Washio Takumi, Yamashita Hiroshi, Kariya Taro, Imai Yasushi, Nakagawa Machiko, Kadooka Yoshimasa, Nagai Ryozo, Hisada Toshiaki, Sugiura Seiryo
Department of Human and Engineered Environmental Studies, Graduate School of Frontier Sciences, The University of Tokyo, Kashiwanoha, Japan.
Pacing Clin Electrophysiol. 2013 Mar;36(3):309-21. doi: 10.1111/pace.12057.
Recent studies, supported by advances in computer science, have successfully simulated the excitation and repolarization processes of the heart, based on detailed cell models of electrophysiology and implemented with realistic morphology.
In this study, we extend these approaches to simulate the body surface electrocardiogram (ECG) of specific individuals. Patient-specific finite element models of the heart and torso are created for four patients with various heart diseases, based on clinical data including computer tomography, while the parallel multi-grid method is used to solve the dynamic bi-domain problem. Personalization procedures include demarcation of nonexcitable tissue, allocation of the failing myocyte model of electrophysiology, and modification of the excitation sequence. In particular, the adjustment of QRS morphology requires iterative computations, facilitated by the simultaneous visualization of the propagation of excitation in the heart, average QRS vector in the torso, and 12-lead ECG.
In all four cases we obtained reasonable agreement between the simulated and actual ECGs. Furthermore, we also simulated the ECGs of three of the patients under bi-ventricular pacing, and once again successfully reproduced the actual ECG morphologies. Since no further adjustments were made to the heart models in the pacing simulations, the good agreement provides strong support for the validity of the models.
These results not only help us understand the cellular basis of the body surface ECG, but also open the possibility of heart simulation for clinical applications.
在计算机科学进展的支持下，最近的研究基于详细的电生理细胞模型并结合实际形态，成功模拟了心脏的兴奋和复极化过程。
在本研究中，我们扩展这些方法来模拟特定个体的体表心电图（ECG）。基于包括计算机断层扫描在内的临床数据，为四名患有各种心脏病的患者创建了心脏和躯干的患者特异性有限元模型，同时使用并行多网格方法来解决动态双域问题。个性化程序包括不可兴奋组织的划分、电生理衰竭心肌细胞模型的分配以及兴奋序列的修改。特别是，QRS波形态的调整需要迭代计算，通过同时可视化心脏中兴奋的传播、躯干中的平均QRS向量和12导联心电图来促进。
在所有四个病例中，我们在模拟心电图和实际心电图之间获得了合理的一致性。此外，我们还模拟了三名患者在双心室起搏下的心电图，并再次成功再现了实际心电图形态。由于在起搏模拟中未对心脏模型进行进一步调整，良好的一致性为模型的有效性提供了有力支持。
这些结果不仅有助于我们理解体表心电图的细胞基础，还为临床应用的心脏模拟开辟了可能性。
