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Published on: February 13, 2021
Effects of Purkinje Fiber Conduction Block on Cardiac Pump Function: Computational Modeling Study
Sandra P Hager1, Vahid Ziaei-Rad1, Jenny S Choy2
1Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA.
Insights
Cardiac conduction abnormalities, like left bundle branch block, significantly impair left ventricular pump function. Our computational model reveals how Purkinje fiber network blocks impact ejection fraction and cardiac performance.
Area of Science:
- Cardiovascular Physiology
- Computational Biology
- Biomedical Engineering
Background:
- Cardiac conditions can disrupt the Purkinje fiber network, affecting left ventricular (LV) pump function.
- Understanding these disruptions is crucial for diagnosing and treating heart dysfunction.
Purpose of the Study:
- To develop and utilize a computational framework analyzing the impact of Purkinje fiber network conduction abnormalities on LV electromechanics and pump function.
- To investigate the relationship between conduction block location and cardiac performance metrics.
Main Methods:
- Coupling electrical propagation in a Purkinje fiber network with LV electromechanics.
- Simulating conduction blocks at various locations within the Purkinje fiber network.
- Analyzing changes in ejection fraction (EF), peak pressure, myocardial activation delay, and systolic dyssynchrony index (SDI).
Main Results:
- Left bundle branch block (LBBB) caused the most significant reduction in EF (59% to 46%) and peak pressure.
- Left anterior fascicle block resulted in smaller functional changes compared to LBBB.
- A nonlinear relationship was observed between activation delay/SDI and EF/myocardial strain, with a threshold identified around 240 ms activation duration and 8.4% SDI.
Conclusions:
- LV pump function is highly sensitive to the location of conduction blocks within the Purkinje fiber network.
- The study provides a mechanistic framework for understanding how Purkinje fiber conduction abnormalities lead to LV pump dysfunction.
- Identified thresholds for activation delay and SDI predict significant decreases in cardiac performance.
Abstract:
Cardiac and hemodynamic conditions such as myocardial infarct, cardiomyopathy, hypertension, and aortic valve disease can impair conduction within the Purkinje fiber network and compromise left ventricular (LV) pump function. We developed a computational framework that couples electrical propagation in a structurally organized Purkinje fiber network with LV electromechanics to analyze the impact of conduction abnormalities on cardiac performance. A baseline simulation reproduced physiological activation patterns and pump indices consistent with healthy human data. Conduction block was then introduced at different locations within the Purkinje fiber network. LV pump function was strongly dependent on block location: left bundle branch block (LBBB) produced the largest reduction in ejection fraction (EF) (59% to 46%) and peak pressure (119 to 97 mmHg), whereas left anterior fascicle block caused smaller functional changes. Across simulations, myocardial activation delay and systolic dyssynchrony index (SDI) exhibited a nonlinear relationship with EF and myocardial strain. A threshold behavior was identified at a simulated LV activation duration of approximately 240 ms and an SDI of 8.4%, beyond which EF and strain decreased by about 5% relative to baseline. These findings provide a mechanistic framework to investigate how Purkinje fiber network conduction abnormalities influence LV pump dysfunction.
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