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Roel Meiburg¹, Jesse H J Rijks², Ahmed S Beela^1,3

¹Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 40, 6200 MD, Maastricht, The Netherlands.

Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology

|June 12, 2023

概括

包括His-bundle pacing (HBP) 在内的导电系统节奏,与传统方法相比,可以改善心脏功能. 非选择性左束分支节奏 (nsLBBP) 在HBP无法实现时提供了一个可行的替代方案,平衡左和右心室功能.

科学领域:

心脏电生理学心脏电生理学
心血管力学心血管力学
计算生物学计算生物学

背景情况:

心脏起器疗法正在从右心室顶部节奏 (RVAP) 和双心室节奏 (BiVP) 演变为导电系统节奏.
直接比较节奏模式对心脏功能的影响是由于实际限制而具有挑战性的.

研究的目的:

以计算方式比较各种心脏节奏策略的电气,机械和血液动力学后果.
在虚拟心脏模型中评估不同节拍方法对心脏功能的影响.

主要方法:

用Eikonal模型在3D几何上计算电气激活地图,用于不同的节奏策略.
一个集成的机械和血液动力学模型 (CircAdapt) 用于模拟应变,心肌工作和血液动力学.
对选择性His捆绑节奏 (HBP),选择性左捆枝节奏 (LBB),非选择性LBB节奏 (nsLBBP),LV隔膜节奏,BiVP和RVAP进行了模拟结果的比较.

主要成果:

HBP表现出最生理的电激活和同质的机械行为.
nsLBBP提供了左心室 (LV) 和右心室 (RV) 功能之间的平衡,减少了RV负载,但增加了LV收缩异质性.
RVAP导致了最慢和最异质的收缩,而BiVP显示了同步的LV-RV激活但异质的收缩.

结论:

计算建模提供了一个平台来评估节奏策略,而不是混变量.
对于心脏功能正常的患者来说,nsLBBP是HBP的实用替代品,优化了LV和RV功能.
这项研究强调了导电系统节奏的潜力,以提高心脏的效率.

关键词:

计算建模计算建模导电系统的节奏调节血液动力学血液动力学机械学机械学机械学

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