Detailed Anatomical and Electrophysiological Models of Human Atria and Torso for the Simulation of Atrial Activation
Atrial arrhythmias, and specifically atrial fibrillation (AF), induce rapid and irregular activation patterns that appear on the torso surface as abnormal P-waves in electrocardiograms and body surface potential maps (BSPM). In recent years both P-waves and the BSPM have been used to identify the mechanisms underlying AF, such as localizing ectopic foci or high-frequency rotors. However, the relationship between the activation of the different areas of the atria and the characteristics of the BSPM and P-wave signals are still far from being completely understood. In this work we developed a multi-scale framework, which combines a highly-detailed 3D atrial model and a torso model to study th…
Analysis of in-silico body surface P-wave integral maps show important differences depending on the connections between coronary sinus and left atrium
The electrical connections between the atrial coronary sinus (CS) and the left atrial (LA) myocardium have an effect on the overall atrial activation pattern and the P-wave morphology. In this study, we use our validated multi-scale 3D human atrial-torso model to elucidate which electro-anatomical configuration of connections between CS and LA more accurately reproduces a set of body surface P-wave integral maps (BSPiM) acquired in the clinic. We performed atrial biophysical simulations by pacing in distal and proximal LA sites. The corresponding in-silico BSPiM were then computed and compared with published clinical patterns obtained from patients. Important differences in BSPiM were obser…
Modelización computacional cardiaca
[EN] Cardiovascular diseases currently have a major social and economic impact, constituting one of the leading causes of mortality and morbidity. Personalized computational models of the heart are demonstrating their usefulness both to help understand the mechanisms underlying cardiac disease, and to optimize their treatment and predict the patient's response. Within this framework, the Spanish Research Network for Cardiac Computational Modelling (VHeart-SN) has been launched. The general objective of the VHeart-SN network is the development of an integrated, modular and multiscale multiphysical computational model of the heart. This general objective is addressed through the following spe…
Modeling Drug Effects on Personalized 3D Models of the Heart: A Simulation Study
[EN] The use of anti-arrhythmic drugs is common to treat heart rhythm disorders. Computational modeling and simulation are powerful tools that can be used to investigate the effects of specific drugs on cardiac electrophysiology. In this work a patient-specific anatomical heart model is built to study the effects of dofetilide, a drug that affects IKr current in cardiac cells. We study the multi-scale effects of the drug, from cellular to organ level, by simulating electrical propagation on tissue coupled cellular ion kinetics for several heart beats. Different cell populations configurations namely endocardial, midmyocardial and epicardial are used to test the effect of tissue heterogeneit…
Ventricular Tachycardia and Early Fibrillation in Patients With Brugada Syndrome and Ischemic Cardiomyopathy Show Predictable Frequency-Phase Properties on the Precordial ECG Consistent With the Respective Arrhythmogenic Substrate
[EN] Background¿ Ventricular fibrillation (VF) has been proposed to be maintained by localized high-frequency sources. We tested whether spectral-phase analysis of the precordial ECG enabled identification of periodic activation patterns generated by such sources. Methods and Results¿Precordial ECGs were recorded from 15 ischemic cardiomyopathy and 15 Brugada syndrome (type 1 ECG) patients during induced VF and analyzed in the frequency-phase domain. Despite temporal variability, induced VF episodes lasting 19.6±7.9 s displayed distinctly high power at a common frequency (shared frequency, 5.7±1.1 Hz) in all leads about half of the time. In patients with Brugada syndrome, phase analysis of …
Small bowel motility: relationship between smooth muscle contraction and electroenterogram signal.
A study is made to correlate the electrical and mechanical activity of the smooth muscle of the small bowel. Bioelectrical signal recording from the intestinal serosa (electroenterogram) comprises a slow wave (SW) and spike burst (SB), though only the latter reflects intestinal pressure. The electroenterogram and smooth muscle pressure are simultaneously recorded in the canine small bowel. Spectral and time series analysis of the electroenterogram are performed to establish those electrical parameters that best reflect intestinal pressure. The results reveal an underlying correlation between the estimated parameters of electrical activity and smooth muscle pressure. In addition, parameters …
Non-invasive localization of atrial ectopic beats by using simulated body surface P-wave integral maps
Non-invasive localization of continuous atrial ectopic beats remains a cornerstone for the treatment of atrial arrhythmias. The lack of accurate tools to guide electrophysiologists leads to an increase in the recurrence rate of ablation procedures. Existing approaches are based on the analysis of the P-waves main characteristics and the forward body surface potential maps (BSPMs) or on the inverse estimation of the electric activity of the heart from those BSPMs. These methods have not provided an efficient and systematic tool to localize ectopic triggers. In this work, we propose the use of machine learning techniques to spatially cluster and classify ectopic atrial foci into clearly diffe…
Factors affecting basket catheter detection of real and phantom rotors in the atria: A computational study
[EN] Anatomically based procedures to ablate atrial fibrillation (AF) are often successful in terminating paroxysmal AF. However, the ability to terminate persistent AF remains disappointing. New mechanistic approaches use multiple-electrode basket catheter mapping to localize and target AF drivers in the form of rotors but significant concerns remain about their accuracy. We aimed to evaluate how electrode-endocardium distance, far-field sources and inter-electrode distance affect the accuracy of localizing rotors. Sustained rotor activation of the atria was simulated numerically and mapped using a virtual basket catheter with varying electrode densities placed at different positions withi…
Atrial Fibrosis Hampers Non-invasive Localization of Atrial Ectopic Foci From Multi-Electrode Signals: A 3D Simulation Study
[EN] Introduction: Focal atrial tachycardia is commonly treated by radio frequency ablation with an acceptable long-term success. Although the location of ectopic foci tends to appear in specific hot-spots, they can be located virtually in any atrial region. Multi-electrode surface ECG systems allow acquiring dense body surface potential maps (BSPM) for non-invasive therapy planning of cardiac arrhythmia. However, the activation of the atria could be affected by fibrosis and therefore biomarkers based on BSPM need to take these effects into account. We aim to analyze the effect of fibrosis on a BSPM derived index, and its potential application to predict the location of ectopic foci in the …
Modelización computacional cardiaca
Resumen Las enfermedades cardiovasculares tienen en la actualidad un gran impacto social y economico y constituyen una de las principales causas de mortalidad y morbilidad. Los modelos computacionales personalizados del corazon estan demostrando ser utiles tanto para ayudar a comprender los mecanismos subyacentes a las patologias cardiacas como para optimizar su tratamiento prediciendo la respuesta del paciente. En este contexto, se ha puesto en marcha la Red Espanola de Investigacion en Modelizacion Computacional Cardiaca (V-Heart SN). El objetivo general de V-Heart SN es el desarrollo de un modelo computacional multifisico y multiescala integrado del corazon. Este objetivo general se abor…
Dofetilide effects on the inhibition by trains of subthreshold conditioning stimuli.
We investigated the electrophysiological actions of dofetilide upon the ventricular myocardium to determine whether the drug modifies the inhibitory effects of subthreshold stimuli trains upon ventricular refractoriness. In nine Langendorff perfused rabbit hearts, ventricular epicardial electrodes were used to determine the following parameters at baseline and during dofetilide perfusion (0.5 micromolar): effective (ERP) and functional (FRP) refractory periods, conduction velocity (CV), wavelength (WL), and ERP prolongation (inhibitory effect) induced by subthreshold stimuli trains (STr) at pulse frequencies of 100, 300, and 600 Hz. Dofetilide significantly prolongs ventricular refractorine…