Computational Modeling for Cardiac Resynchronization Therapy
Angela W C Lee1, Caroline Mendonca Costa2, Marina Strocchi2
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK. angela.lee@kcl.ac.uk.
Insights
Cardiac resynchronization therapy (CRT) improves heart failure (HF) but lacks efficacy in many patients. Advanced cardiac models show promise for optimizing CRT and understanding HF, but require further development for widespread clinical use.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Biology
Background:
- Heart failure (HF) affects millions globally, often involving ventricular dyssynchrony.
- Cardiac resynchronization therapy (CRT) is a treatment for HF, but 40-50% of patients show no response.
- Understanding the mechanisms of HF and CRT response is crucial for improving patient outcomes.
Purpose of the Study:
- To review the application of multi-scale cardiac models in studying heart failure (HF) and cardiac resynchronization therapy (CRT).
- To explore the potential of computational modeling for optimizing CRT device settings and lead placement.
- To discuss the challenges and future directions for biophysically-based cardiac models in clinical practice.
Main Methods:
- Review of existing literature on cardiac modeling for HF and CRT.
- Analysis of multi-scale models incorporating electrophysiology, electromechanics, and hemodynamics.
- Discussion of data requirements and computational resources for model development.
Main Results:
- Cardiac models are valuable tools for investigating HF pathophysiology and CRT response.
- Multi-scale models aid in studying optimal CRT device settings and lead locations.
- Current limitations include extensive data needs and high computational costs, restricting use to small patient cohorts.
Conclusions:
- Biophysically-based cardiac models hold significant potential for personalized HF diagnosis and treatment.
- Overcoming technical challenges in data acquisition and computation is key to clinical translation.
- Future advancements could establish cardiac modeling as a standard clinical tool for HF management.
Abstract:
Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure (HF) patients with an electrical substrate pathology causing ventricular dyssynchrony. However 40-50% of patients do not respond to treatment. Cardiac modeling of the electrophysiology, electromechanics, and hemodynamics of the heart has been used to study mechanisms behind HF pathology and CRT response. Recently, multi-scale dyssynchronous HF models have been used to study optimal device settings and optimal lead locations, investigate the underlying cardiac pathophysiology, as well as investigate emerging technologies proposed to treat cardiac dyssynchrony. However the breadth of patient and experimental data required to create and parameterize these models and the computational resources required currently limits the use of these models to small patient numbers. In the future, once these technical challenges are overcome, biophysically based models of the heart have the potential to become a clinical tool to aid in the diagnosis and treatment of HF.
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