Optimizing A-V and V-V Delay in Cardiac Resynchronization Therapy in Simulations Including Ventricle Heterogeneity

R. Miri, M. Reumann, D. Farina, B. Osswald, and O. Dössel (Germany)


Congestive heart failure, biventricular pacing, reduced con duction velocity, atrioventricular block, left bundle branch block, cellular automaton


Congestive heart failure (CHF) is affecting more than 15 million people in the western population with an increasing number. Biventricular pacing as Cardiac Resynchroniza tion Therapy (CRT) is a recognized therapy for the treat ment of heart failure. The present paper investigates the op timal pacing sites and stimuli delays for stimulation, based on a complex three-dimensional computer model of the hu man heart. The anatomical features were derived from the Visible Man data set. The excitation propagation and intra ventricular conduction were simulated with Ten Tusscher electrophysiological cell model and an adaptive cellular au tomaton. Biventricular pacing in AV block III and LBBB with different interventricular conduction delays were in vestigated. The simulated activation times of different my ocytes in the healthy and diseased heart model are com pared in terms of root mean square error (ERMS). The outcomes of the investigation underline that the position ing of the electrodes considering a proper atrioventricular and intraventricular delay influences the efficiency of the resynchronization therapy. The results of this optimization strategy may assist the surgeon in therapy planning.

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