Bhagirath P, van der Graaf A W M, de Hooge J, de Groot N M S, Götte M J W
Department of Cardiology, Haga Teaching Hospital, Leyweg 275, 2545 CH, The Hague, The Netherlands.
Department of Cardiology, Thorax Center, Erasmus Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
J Transl Med. 2016 May 25;14(1):147. doi: 10.1186/s12967-016-0902-0.
Integration of whole-heart activation simulations and inverse potential mapping (IPM) could benefit the guidance and planning of electrophysiological procedures. Routine clinical application requires a fast and adaptable workflow. These requirements limit clinical translation of existing simulation models. This study proposes a comprehensive finite element model (FEM) based whole-heart computational workflow suitable for IPM and simulations.
Three volunteers and eight patients with premature ventricular contractions underwent body surface potential (BSP) acquisition followed by a cardiac MRI (CMR) scan. The cardiac volumes were segmented from the CMR images using custom written software. The feasibility to integrate tissue-characteristics was assessed by generating meshes with virtual edema and scar. Isochronal activation maps were constructed by identifying the fastest route through the cardiac volume using the Möller-Trumbore and Floyd-Warshall algorithms. IPM's were reconstructed from the BSP's.
Whole-heart computational meshes were generated within seconds. The first point of atrial activation on IPM was located near the crista terminalis of the superior vena cave into the right atrium. The IPM demonstrated the ventricular epicardial breakthrough at the attachment of the moderator band with the right ventricular free wall. Simulations of sinus rhythm were successfully performed. The conduction through the virtual edema and scar meshes demonstrated delayed activation or a complete conductional block respectively.
The proposed FEM based whole-heart computational workflow offers an integrated platform for cardiac electrical assessment using simulations and IPM. This workflow can incorporate patient-specific electrical parameters, perform whole-heart cardiac activation simulations and accurately reconstruct cardiac activation sequences from BSP's.
全心脏激活模拟与逆电位映射（IPM）的整合有助于电生理手术的指导与规划。常规临床应用需要快速且适应性强的工作流程。这些要求限制了现有模拟模型的临床转化。本研究提出了一种基于有限元模型（FEM）的适用于IPM和模拟的全心脏计算工作流程。
三名志愿者和八名室性早搏患者接受体表电位（BSP）采集，随后进行心脏磁共振成像（CMR）扫描。使用定制软件从CMR图像中分割出心脏体积。通过生成带有虚拟水肿和瘢痕的网格来评估整合组织特征的可行性。使用Möller-Trumbore和Floyd-Warshall算法通过确定穿过心脏体积的最快路径来构建等时激活图。从BSP重建IPM。
在数秒内生成了全心脏计算网格。IPM上心房激活的第一点位于上腔静脉进入右心房的终嵴附近。IPM显示室间隔带与右心室游离壁附着处的心室心外膜突破。成功进行了窦性心律模拟。通过虚拟水肿和瘢痕网格的传导分别显示出激活延迟或完全传导阻滞。
所提出的基于FEM的全心脏计算工作流程提供了一个使用模拟和IPM进行心脏电评估的集成平台。该工作流程可以纳入患者特定的电参数，进行全心脏心脏激活模拟，并从BSP准确重建心脏激活序列。
