Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy

Area of Science:

• Computational modeling
• Biomedical engineering
• Cardiology

Background:

• Cardiac resynchronization therapy (CRT) is crucial for heart failure patients with left bundle branch block.
• Optimizing CRT requires personalized approaches to account for individual patient anatomy and electrophysiology.
• Current methods for optimizing CRT can be limited in providing real-time, personalized guidance.

Purpose of the Study:

• To develop and validate a computational framework for evaluating virtual CRT scenarios.
• To compare the effectiveness of different CRT configurations using patient-specific electro-mechanical simulations.
• To identify optimal electrode placements and pacing delays for improved CRT outcomes.

Main Methods:

• Personalized electro-mechanical numerical simulations for patients with left bundle branch block.
• Calibration using Electro-Anatomical Mapping System (EAMS) data, ventricular pressures, and volumes.
• Validation of calibration with EAMS data from right pacing conditions.
• Exploration of scenarios with and without cardiac fibrosis, varying electrode positions and ventriculo-ventricular delays.

Main Results:

• The latest activated segment during sinus rhythm is identified as an effective left electrode placement for non-fibrotic cases.
• Pacing the right electrode before the left electrode appears to enhance CRT performance in non-fibrotic patients.
• Positioning the right electrode midway between the base and apex may improve CRT performance.

Conclusions:

• The developed computational framework offers a tool for optimizing individual CRT strategies.
• Preliminary findings provide insights into optimal electrode placement and pacing delays for enhanced CRT efficiency.
• This approach, incorporating epicardial veins and electrode movement, advances computational tools for clinical CRT guidance.