Abstract: Abstract Atrial arrhythmias are frequently treated using catheter ablation during electrophysiological (EP) studies. However, success rates are only moderate and could be improved with the help of personalized simulation models of the atria. In this work, we present a workflow to generate and validate personalized EP simulation models based on routine clinical computed tomography (CT) scans and intracardiac electrograms. From four patient data sets, we created anatomical models from angiographic CT data with an automatic segmentation algorithm. From clinical intracardiac catheter recordings, individual conduction velocities were calculated. In these subject-specific EP models, we simulated different pacing maneuvers and measurements with circular mapping catheters that were applied in the respective patients. This way, normal sinus rhythm and pacing from a coronary sinus catheter were simulated. Wave directions and conduction velocities were quantitatively analyzed in both clinical measurements and simulated data and were compared. On average, the overall difference of wave directions was 15° (8%), and the difference of conduction velocities was 16 cm/s (17%). The method is based on routine clinical measurements and is thus easy to integrate into clinical practice. In the long run, such personalized simulations could therefore assist treatment planning and increase success rates for atrial arrhythmias.
Abstract: Despite the commonly accepted notion that action potential duration (APD) is distributed heterogeneously throughout the ventricles and that the associated dispersion of repolarization is mainly responsible for the shape of the T-wave, its concordance and exact morphology are still not completely understood. This paper evaluated the T-waves for different previously measured heterogeneous ion channel distributions. To this end, cardiac activation and repolarization was simulated on a high resolution and anisotropic biventricular model of a volunteer. From the same volunteer, multichannel ECG data were obtained. Resulting transmembrane voltage distributions for the previously measured heterogeneous ion channel expressions were used to calculate the ECG and the simulated T-wave was compared to the measured ECG for quantitative evaluation. Both exclusively transmural (TM) and exclusively apico-basal (AB) setups produced concordant T-waves, whereas interventricular (IV) heterogeneities led to notched T-wave morphologies. The best match with the measured T-wave was achieved for a purely AB setup with shorter apical APD and a mix of AB and TM heterogeneity with M-cells in midmyocardial position and shorter apical APD. Finally, we probed two configurations in which the APD was negatively correlated with the activation time. In one case, this meant that the repolarization directly followed the sequence of activation. Still, the associated T-waves were concordant albeit of low amplitude.
Abstract: Ventricular wall deformation is widely assumed to have an impact on the morphology of the T-wave that can be measured on the body surface. This study aims at quantifying these effects based on an in silico approach. To this end, we used a hybrid, static-dynamic approach: action potential propagation and repolarization were simulated on an electrophysiologically detailed but static 3-D heart model while the forward calculation accounted for ventricular deformation and the associated movement of the electrical sources (thus, it was dynamic). The displacement vectors that describe the ventricular motion were extracted from cinematographic and tagged MRI data using an elastic registration procedure. To probe to what extent the T-wave changes depend on the synchrony/asynchrony of mechanical relaxation and electrical repolarization, we created three electrophysiological configurations, each with a unique QT time: a setup with physiological QT time, a setup with pathologically short QT time (SQT), and pathologically long QT time (LQT), respectively. For all three electrophysiological configurations, a reduction of the T-wave amplitude was observed when the dynamic model was used for the forward calculations. The largest amplitude changes and the lowest correlation coefficients between the static and dynamic model were observed for the SQT setup, followed by the physiological QT and LQT setups.
Abstract: Conduction velocity (CV) and CV restitution are important substrate parameters for understanding atrial arrhythmias. The aim of this work is to (i) present a simple but feasible method to measure CV restitution in-vivo using standard circular catheters, and (ii) validate its feasibility with data measured during incremental pacing. From five patients undergoing catheter ablation, we analyzed 8 datasets from sinus rhythm and incremental pacing sequences. Every wavefront was measured with a circular catheter and the electrograms were analyzed with a cosine-fit method that calculated the local CV. For each pacing cycle length, the mean local CV was determined. Furthermore, changes in global CV were estimated from the time delay between pacing stimulus and wavefront arrival. Comparing local and global CV between pacing at 500 and 300 ms, we found significant changes in 7 of 8 pacing sequences. On average, local CV decreased by 2015% and global CV by 1713%. The method allows for in-vivo measurements of absolute CV and CV restitution during standard clinical procedures. Such data may provide valuable insights into mechanisms of atrial arrhythmias. This is important both for improving cardiac models and also for clinical applications, such as characterizing arrhythmogenic substrates during sinus rhythm.
M. Wilhelms, O. Dössel, and G. Seemann. In silico investigation of electrically silent acute cardiac ischemia in the human ventricles. In IEEE Transactions on Biomedical Engineering, vol. 58(10) , pp. 2961-2964, 2011[request PDF][doi]
Abstract: Acute cardiac ischemia, which is caused by the occlusion of a coronary artery, often leads to lethal ventricular arrhythmias or heart failure. The early diagnosis of this pathology is based on changes of the electrocardiogram (ECG), i.e. mainly shifts of the ST segment. However, the underlying mechanisms responsible for these shifts are not completely understood. Furthermore, clinical observations indicate that some acute ischemia cases can hardly be detected using standard 12-lead ECG only. Therefore, multi-scale computer simulations of cardiac ischemia using realistic models of human ventricles were carried out in this work. For this purpose, the transmembrane voltage distributions in the heart and the corresponding body surface potentials were computed with varying transmural extent of the ischemic region at different ischemia stages. Some of the simulated ischemia cases were electrically silent, i.e. they could hardly be identified in the 12-lead ECG.
Abstract: In this paper, we present an efficient method to estimate changes in forward-calculated body surface potential maps (BSPMs) caused by variations in tissue conductivities. For blood, skeletal muscle, lungs, and fat, the influence of conductivity variations was analyzed using the principal component analysis (PCA). For each single tissue, we obtained the first PCA eigenvector from seven sample simulations with conductivities between ±75% of the default value. We showed that this eigenvector was sufficient to estimate the signal over the whole conductivity range of ±75%. By aligning the origins of the different PCA coordinate systems and superimposing the single tissue effects, it was possible to estimate the BSPM for combined conductivity variations in all four tissues. Furthermore, the method can be used to easily calculate confidence intervals for the signal, i.e., the minimal and maximal possible amplitudes for given conductivity uncertainties. In addition to that, it was possible to determine the most probable conductivity values for a given BSPM signal. This was achieved by probing hundreds of different conductivity combinations with a numerical optimization scheme. In conclusion, our method allows to efficiently predict forward-calculated BSPMs over a wide range of conductivity values from few sample simulations.
Abstract: Background: The prevalence of atrial fibrillation is increased in patients with end stage renal disease (ESRD). Previous studies suggested that extracellular electrolyte alterations due to hemodialysis therapy could be pro-arrhythmic.
Methods: Multi-scale models were used for a consequent analysis of the effects of extracellular ion concentration changes on atrial electrophysiology. Simulations were based on measured electrolyte concentrations from ESRD patients.
Results: Simulated conduction velocity and effective refractory period are decreased at the end of a hemodialysis session, with potassium having the strongest influence. P-wave is prolonged in patients undergoing hemodialysis therapy in the simulation as in measurements.
Conclusions: Electrolyte concentration alterations impact atrial electrophysiology from the action potential level to the P-wave and can be pro-arrhythmic, especially because of induced hypokalemia. Analysis of blood electrolytes enables patient-specific electrophysiology modeling. We are providing a tool to investigate atrial arrhythmias associated with hemodialysis therapy, which in future can be used to prevent such complications.
Abstract: In this work, a new framework is presented that is suitable to solve the cardiac bidomain equation efficiently using the scientific computing library PETSc. Furthermore, the framework is able to modularly combine different ionic channels and is flexible enough to include arbitrary heterogeneities in ionic or coupling channel density. The ability of this framework is demonstrated in an example simulation in which the three-dimensional electrophysiological heterogeneity was adjusted in order to get a positive T-wave in the body electrocardiogram (ECG).
Abstract: Simulations of the electrophysiological behavior of the heart improve the comprehension of the mechanisms of the cardiovascular system. Furthermore, the mathematical modeling will support diagnosis and therapy of patients suffering from heart diseases. In this paper, the chain of modeling of the electrical function in the heart is described. The components are explained briefly, namely modeling of cardiac geometry, reconstructing the cardiac electrophysiology and excitation propagation. Additionally, the mathematical methods allowing to implement and solve these models are outlined. The three recently more investigated cases atrial fibrillation, ischemia and long-QT syndrome are described and show how cardiac modeling can support cardiologists in answering their open questions.
Abstract: This paper examined the effects that different tissue conductivities had on forward-calculated ECGs. To this end, we ranked the influence of tissues by performing repetitive forward calculations while varying the respective tissue conductivity. The torso model included all major anatomical structures like blood, lungs, fat, anisotropic skeletal muscle, intestine, liver, kidneys, bone, cartilage, and spleen. Cardiac electrical sources were derived from realistic atrial and ventricular simulations. The conductivity rankings were based on one of two methods: First, we considered fixed percental conductivity changes to probe the sensitivity of the ECG regarding conductivity alterations. Second, we set conductivities to the reported minimum and maximum values to evaluate the effects of the existing conductivity uncertainties. The amplitudes of both atrial and ventricular ECGs were most sensitive for blood, skeletal muscle conductivity and anisotropy as well as for heart, fat, and lungs. If signal morphology was considered, fat was more important whereas skeletal muscle was less important. When comparing atria and ventricles, the lungs had a larger effect on the atria yet the heart conductivity had a stronger impact on the ventricles. The effects of conductivity uncertainties were significant. Future studies dealing with electrocardiographic simulations should consider these effects.
Y. Jiang, C. Qian, R. Hanna, D. Farina, and O. Dössel. Determination of optimal electrode positions of a wearable ECG monitoring system for detection of acute myocardial infarction: A simulation study. In Medical & Biological Engineering & Computing (in revision), 2010[request PDF]
Abstract: Atrial arrhythmias, such as atrial flutter or fibrillation, are frequent indications for catheter ablation. Recorded intracardiac electrograms (EGMs) are, however, mostly evaluated subjectively by the physicians. In this paper, we present a method to quantitatively extract the wave direction and the local conduction velocity from one single beat in a circular mapping catheter signal. We simulated typical clinical EGMs to validate the method. We then showed that even with noise, the average directional error was below 10(°) and the average velocity error was below 5.4 cm/s. In a realistic atrial simulation, the method could clearly distinguish between stimuli from different pulmonary veins. We further analyzed eight clinical data segments from three patients in normal sinus rhythm and with stimulation. We obtained stable wave directions for each segment and conduction velocities between 70 and 115 cm/s. We conclude that the method allows for easy quantitative analysis of single macroscopic wavefronts in intracardiac EGMs, such as during atrial flutter or in typical clinical stimulation procedures after termination of atrial fibrillation. With corresponding simulated data, it can provide an interface to personalize electrophysiological (EP) models. Furthermore, it could be integrated into EP navigation systems to provide quantitative data of high diagnostic value to the physician
Abstract: Cardiac tissue exhibits spatially heterogeneous electrophysiological properties. In cardiac diseases, these properties also change in time. This study introduces a framework to investigate their role in cardiac ischemia using mathematical modeling and computational simulations at cellular and tissue level. Ischemia was incorporated by reproducing effects of hyperkalemia, acidosis, and hypoxia with a human electrophysiological model. In tissue, spatial heterogeneous ischemia was described by central ischemic (CIZ) and border zone. Anisotropic conduction was simulated with a bidomain approach in an anatomical ventricle model including realistic fiber orientation and transmural, apico-basal, and interventricular electrophysiological heterogeneities. A model of electrical conductivity in a human torso served for ECG calculations. Ischemia increased resting but reduced peak voltage, action potential duration, and upstroke velocity. These effects were strongest in subepicardial cells. In tissue, conduction velocity decreased towards CIZ but effective refractory period increased. At 10 min of ischemia 19% of subepi- and 100% of subendocardial CIZ cells activated with a delay of 34.6+/-7.8 ms and 55.9+/-18.8 ms, respectively, compared to normal. Significant ST elevation and premature T wave end appeared only with the subepicardial CIZ. The model reproduced effects of ischemia at cellular and tissue level. The results suggest that the presented in silico approach can complement experimental studies, e.g., in understanding the role of ischemia or the onset of arrhythmia.
Y. Jiang, D. Farina, M. Bar-Tal, and O. Dössel. An impedance based catheter positioning system for cardiac mapping and navigation. In IEEE Transactions on Biomedical Engineering, vol. 56(8) , pp. 1963-1970, 2009[request PDF]
Abstract: Over the last years, nonfluoroscopic in vivo cardiac mapping and navigation systems have been developed and successfully applied in clinical electrophysiology. Clearly, a trend can be observed to introduce more sensors into the measurement system so that physiological information can be gathered simultaneously and more efficiently and the duration of procedure can be shortened significantly. However, it would not be realistic to equip each catheter electrode with a localizer, e.g., by embedding a miniature magnetic location sensor. Therefore, in this paper, an alternate approach has been worked out to efficiently localize multiple catheter electrodes by considering the impedance between electrodes in the heart and electrode patches on the body surface. In application of the new technique, no additional expensive and sophisticated hardware is required other than the currently existing cardiac navigation system. A tank model and a computerized realistic human model are employed to support the development of the positioning system. In the simulation study, the new approach achieves an average localization error of less than 1 mm, which proves the feasibility of the impedance-based catheter positioning system. Consequently, the new positioning system can provide an inexpensive and accurate solution to improve the efficiency and efficacy of catheter ablation.
D. Farina, Y. Jiang, and O. Dössel. Acceleration of FEM-based transfer matrix computation for forward and inverse problems of electrocardiography. In Med Biol Eng Comput, vol. 47(12) , pp. 1229-1236, 2009[request PDF]
Abstract: The distributions of transmembrane voltage (TMV) within the cardiac tissue are linearly connected with the patient's body surface potential maps (BSPMs) at every time instant. The matrix describing the relation between the respective distributions is referred to as the transfer matrix. This matrix can be employed to carry out forward calculations in order to find the BSPM for any given distribution of TMV inside the heart. Its inverse can be used to reconstruct the cardiac activity non-invasively, which can be an important diagnostic tool in the clinical practice.The computation of this matrix using the finite element method can be quite time-consuming. In this work, a method is proposed allowing to speed up this process by computing an approximate transfer matrix instead of the precise one. The method is tested on three realistic anatomical models of real-world patients. It is shown that the computation time can be reduced by 50% without loss of accuracy.
Y. Jiang, C. Qian, R. Hanna, D. Farina, and O. Dössel. Optimization of the electrode positions of multichannel ECG for the reconstruction of ischemic areas by solving the inverse electrocardiographic problem. In International Journal of Bioelectromagnetism (Cover Article), vol. 11(1) , pp. 27-37, 2009[request PDF]
Abstract: The electric conductivity can potentially be used as an additional diagnostic parameter, e.g., in tumour diagnosis. Moreover, the electric conductivity, in connection with the electric field, can be used to estimate the local SAR distribution during MR measurements. In this study, a new approach, called electric properties tomography (EPT) is presented. It derives the patient's electric conductivity, along with the corresponding electric fields, from the spatial sensitivity distributions of the applied RF coils, which are measured via MRI. Corresponding numerical simulations and initial experiments on a standard clinical MRI system underline the principal feasibility of EPT to determine the electric conductivity and the local SAR. In contrast to previous methods to measure the patient's electric properties, EPT does not apply externally mounted electrodes, currents, or RF probes, thus enhancing the practicability of the approach. Furthermore, in contrast to previous methods, EPT circumvents the solution of an inverse problem, which might lead to significantly higher spatial image resolution.
D. Farina, and O. Dössel. Non-invasive model-based localization of ventricular ectopic centers from multichannel ECG. In International Journal of Applied Electromagnetics and Mechanics, vol. 30(3-4) , pp. 289-297, 2009[request PDF]
Abstract: Non-invasive localization of premature ventricular beat (PVB) foci is very important for medical treatment of numerous cardiac diseases. In this work a model-based method of reconstruction of ectopic center locations is investigated.
Within the scope of this method patient's multichannel ECG is used as a reference for optimization of an electrophysiological cardiac model. This model is based on the cellular automaton principle and utilizes anatomical data of the patient. Optimized are coordinates of the ectopic focus as well as excitation conduction velocity of ventricular myocardium. Initial values for these parameters are obtained by solving the linearized problem of electrocardiography in terms of activation times. Optimization is performed by minimization of discrepancy between the simulated and reference ECGs.
The aim of the current work is to estimate the quality of ectopic focus localization delivered by this method. Four sample ectopic beats have been simulated, with their foci located in different regions of the left ventricle. 1% Gaussian noise has been introduced into the resulting ECGs. In this way the "measured" ECG signals for this investigation have been obtained. Afterwards the origin of each ectopic beat has been reconstructed using the model-based approach. The method has demonstrated reliable localization of PVB foci, reconstruction errors have not exceeded 6.1 mm.
M. Reumann, J. Bohnert, G. Seemann, B. Osswald, and O. Dössel. Preventive ablation strategies in a biophysical model of atrial fibrillation based on realistic anatomical data. In IEEE Transactions on Biomedical Engineering, vol. 55(2) , pp. 399-406, 2008[request PDF]
Abstract: Ablation strategies to prevent episodes of paroxysmal atrial fibrillation (AF) have been subject to many clinical studies. The issues mainly concern pattern and transmurality of the lesions. This paper investigates ten different ablation strategies on a multilayered 3-D anatomical model of the atria with respect to 23 different setups of AF initiation in a biophysical computer model. There were 495 simulations carried out showing that circumferential lesions around the pulmonary veins (PVs) yield the highest success rate if at least two additional linear lesions are carried out. The findings compare with clinical studies as well as with other computer simulations. The anatomy and the setup of ectopic beats play an important role in the initiation and maintenance of AF as well as the resulting therapy. The computer model presented in this paper is a suitable tool to investigate different ablation strategies. By including individual patient anatomy and electrophysiological measurement, the model could be parameterized to yield an effective tool for future investigation of tailored ablation strategies and their effects on atrial fibrillation.
D. L. Weiss, D. U. J. Keller, G. Seemann, and O. Dössel. The influence of fibre orientation, extracted from different segments of the human left ventricle, on the activation and repolarization sequence: a simulation study. In Europace, vol. 9(suppl 6) , pp. vi96-vi104, 2007[request PDF]
Abstract: Aims This computational study examined the influence of fibre orientation on the electrical processes in the heart. In contrast to similar previous studies, human diffusion tensor magnetic resonance imaging measurements were used.
Methods The fibre orientation was extracted from distinctive regions of the left ventricle. It was incorporated in a single tissue segment having a fixed geometry. The electrophysiological model applied in the computational units considered transmural heterogeneities. Excitation was computed by means of the monodomain model; the accompanying pseudo-electrocardiograms (ECGs) were calculated.
Results The distribution of fibre orientation extracted from the same transversal section showed only small variations. The fibre information extracted from the equal circumferential but different longitudinal positions showed larger differences, mainly in the imbrication angle. Differences of the endocardial myocyte orientation mainly affected the beginning of the activation sequence. The transmural propagation was faster in areas with larger imbrication angles leading to a narrower QRS complex in pseudo-ECGs.
Conclusion The model can be expanded to simulate electrophysiology and contraction in the whole heart geometry. Embedded in a torso model, the impact of fibre orientation on body surface ECGs and their relation to local pseudo-ECGs can be identified.
Abstract: Investigating the mechanisms underlying the genesis and conduction of electrical excitation in the atria at physiological and pathological states is of great importance. To provide knowledge concerning the mechanisms of excitation, we constructed a biophysical detailed and anatomically accurate computer model of human atria that incorporates both structural and electrophysiological heterogeneities. The three-dimensional geometry was extracted from the visible female dataset. The sinoatrial node (SAN) and atrium, including crista terminalis (CT), pectinate muscles (PM), appendages (APG) and Bachmann's bundle (BB) were segmented in this work. Fibre orientation in CT, PM and BB was set to local longitudinal direction. Descriptions for all used cell types were based on modifications of the Courtemanche et al. model of a human atrial cell. Maximum conductances of Ito, IKr and ICa,L were modified for PM, CT, APG and atrioventricular ring to reproduce measured action potentials (AP). Pacemaker activity in the human SAN was reproduced by removing IK1, but including If, ICa,T, and gradients of channel conductances as described in previous studies for heterogeneous rabbit SAN. Anisotropic conduction was computed with a monodomain model using the finite element method. The transversal to longitudinal ratio of conductivity for PM, CT and BB was 1:9. Atrial working myocardium (AWM) was set to be isotropic. Simulation of atrial electrophysiology showed initiation of APs in the SAN centre. The excitation spread afterwards to the periphery near to the region of the CT and preferentially towards the atrioventricular region. The excitation extends over the right atrium along PM. Both CT and PM activated the right AWM. Earliest activation of the left atrium was through BB and excitation spread over to the APG. The conduction velocities were 0.6ms-1 for AWM, 1.2ms-1 for CT, 1.6ms-1 for PM and 1.1ms-1 for BB at a rate of 63bpm. The simulations revealed that bundles form dominant pathways for atrial conduction. The preferential conduction towards CT and along PM is comparable with clinical mapping. Repolarization is more homogeneous than excitation due to the heterogeneous distribution of electrophysiological properties and hence the action potential duration.
G. Seemann, F. B. Sachse, D. L. Weiß, and O. Dössel. Quantitative reconstruction of cardiac electromechanics in human myocardium: Regional heterogeneity. In J. Cardiovasc. Electrophysiol., vol. 14(S10) , pp. S219-S228, 2003[request PDF]
Abstract: A framework for step-by-step personalization of a computational model of human atria is presented. Beginning with anatomical modeling based on CT or MRI data, next fiber structure is superimposed using a rule-based method. If available, late-enhancement-MRI images can be considered in order to mark fibrotic tissue. A first estimate of individual electrophysiology is gained from BSPM data solving the inverse problem of ECG. A final adjustment of electrophysiology is realized using intracardiac measurements. The framework is applied using several patient data. First clinical application will be computer assisted planning of RF-ablation for treatment of atrial flutter and atrial fibrillation.
Abstract: A computer model of the human heart is presented, that starts with the electrophysiology of single myocardial cells including all relevant ion channels, spans the de- and repolarization of the heart including the generation of the Electrocardiogram (ECG) and ends with the contraction of the heart that can be measured using 4D Magnetic Resonance Imaging (MRI). The model can be used to better understand physiology and pathophysiology of the heart, to improve diagnostics of infarction and arrhythmia and to enable quantitative therapy planning. It can also be used as a regularization tool to gain better solutions of the ill-posed inverse problem of ECG. Movies of the evolution of electrophysiology of the heart can be reconstructed from Body Surface Potential Maps (BSPM) and MRI, leading to a new non-invasive medical imaging technique.
Abstract: Diagnosis of acute cardiac ischemia depends on characteristic shifts of the ST segment. The transmural extent of the ischemic region and the temporal stage of ischemia have an impact on these changes. In this work, computer simulations of realistic ventricles with different transmural extent of the ischemic region were carried out. Furthermore, three stages within the first half hour after the occlusion of the distal left anterior descending coronary artery were regarded. The transmembrane voltage distributions and the corresponding body surface ECGs were calculated. It was observed how the electrophysiological properties worsen in the course of ischemia, so that almost no excitation was initiated in the central ischemic zone 30 minutes after the occlusion. In addition to these temporal effects, also the transmural extent of the ischemic region had an impact on the direction and intensity of the ST segment shift.
C. Schilling, A. Luik, C. Schmitt, and O. Dössel. Descriptors for complex fractionated atrial electrograms: A comparison of three different approaches. In Journal of Electrocardiology (Proc. ICE 2010), vol. 44(2) , pp. e31, 2011[request PDF][doi]
Abstract: Background: Catheter ablation of persistent atrial fibrillation (AF) is challenging. The underlying mechanisms are mostly unknown and discussed very controversially. Automated detection and signal analysis of complex fractionated atrial electrograms (CFAEs) is essential in supporting the physicians during the ablation procedure. To investigate the clinical value of descriptors for CFAEs, we calculate their value before and after pulmonary vein isolation (PVI). Pulmonary vein isolation effects the excitation propagation of AF. This should be detected by every descriptor. We calculated the dominant frequency (DF), the fractionation index (CFE-Idx), and the activity ratio (AR) before and after PVI.
Methods: (1) A common analysis technique of AF is DF analysis. It is an estimation of the atrial activation rates. (2) Ensite-NavX provides an algorithm that delivers a CFE-Idx based on the cycle length of distinguishable local activities in one electrogram. (3) A third method calculates atrial activity with a segmentation algorithm based on a nonlinear energy operator. Complex fractionated atrial electrograms are marked as active segments. The AR is then defined as the ratio between the length of active segments and the total length of the signal [2]. Dominant frequency, CFE-Idx, and AR were compared on data sets of 17 patients suffering from persistent AF. All patients were sent to hospital for catheter ablation. Electrograms of 5 seconds were recorded before and after PVI at customary 46 locations per patient in the left atrium. Nine patients terminated during ablation (A), whereas 8 patients did not terminate (B) and underwent an external cardioversion. Results: The mean DF decreased from 5.7 ± 0.6 to 5.5 ± 0.3 Hz (A) and increased from 5.3 ± 0.5 to 5.5 ± 0.5 Hz (B). Mean CFE-Idx increased from 157 ± 68 to 223 ± 51 milliseconds (A) and from 222 ± 88 to 273 ± 72 milliseconds (B). Mean AR decreased from 0.65 ± 0.1 to 0.63 ± 0.04 (A) and increased from 0.69 ± 0.5 to 0.72 ± 0.1 (B).
Conclusion: More regular excitation should result in higher CFE-Idx and lower DF and AR. We found intergroup differences and could show the influence of PVI on the excitation during AF. The fractionation index of CFE has shown the most distinct results in differentiation of the 2 states of PVI (before/after) and also in differentiation of group A to B. Nevertheless, AR and DF are promising alternatives. Removal of outliers will increase performance of AR and DF.
M. W. Keller, and O. Dössel. Towards simultaneous optical and electrical characterization of the electrode tissue interface in catheter measurements of atrial electrophysiology. In Biomedizinische Technik / Biomedical Engineering (Proc. BMT 2011), vol. 56(s1) , 2011[request PDF]
Abstract: Background: Catheter ablation of complex atrial arrhythmias, such as atrial fibrillation and atypical atrial flutter, is still challenging. Clinically evaluated ablation methods are leading to moderate success rates. Assessments of intracardiac electrograms are often done subjectively by the physician. Automatic algorithms can therefore improve the analysis of complex atrial electrograms (EGMs). In this work, we demonstrate a quantitative analysis of intracardiac EGMs from circular mapping catheters in humans. Both the wave direction and the local conduction velocity (CV) were calculated from individual wave fronts passing the catheter.
Methods: Intracardiac EGMs measured with circular mapping catheters in humans were retrospectively analyzed. Five data sets from 3 patients undergoing catheter ablation of atrial fibrillation or flutter were available. Using a nonlinear energy operator, activation times from 9 bipolar catheter signals were calculated for each atrial activity. The resulting activation pattern was fitted to a cosine-shaped data model that has been validated in a previous simulation study. The cosine phase represented the wave direction. From the cosine amplitude and the catheter radius, the conduction velocity was calculated.
Results: The wave directions in all five measurements were stable with a standard deviation below 10°. Calculated CVs were in the range of 70 to 110 cm/s, which is in accordance with published values. In one patient, electrograms were recorded during atrial stimulation. Stimulation cycle length was decreased from 500 to 300 milliseconds. Conduction velocity decreased by approximately 10% at a cycle length of 300 milliseconds compared with the CV at 500 milliseconds.
Conclusion: The results show the ability to reliably extract wave direction and conduction velocity from intracardiac EGMs recorded with circular mapping catheters. Detected directions were stable, and the CV values were in a physiological range. As individual beats are analyzed, the method will also enable the quantitative study of singular events such as ectopic beats and facilitate the localization of tachycardia origins. Further, it will help to measure substrate parameters such as the CV and even CV restitution behavior. This way, the method can help to identify patient-specific physiological parameters that can be integrated into patient-specific models. Furthermore, it can directly provide quantitative data of high diagnostic value to the examiner and thereby improve clinical success rates.
Abstract: Atrial myofiber orientation is complex and has multiple discrete layers and bundles. A novel robust semi-automatic method to incorporate atrial anisotropy and heterogeneities into patient-specific models is introduced. The user needs to provide 22 distinct seed-points from which a network of auxiliary lines is constructed. These are used to define fiber orientation and myocardial bundles. The method was applied to 14 patient-specific volumetric models derived from CT, MRI and photographic data. Initial electrophysiological simulations show a significant influence of anisotropy and heterogeneity on the excitation pattern and P-wave duration (20.7% shortening). Fiber modeling results show good overall correspondence with anatomical data. Minor modeling errors are observed if more than four pulmonary veins exist in the model. The method is an important step towards creating realistic patient-specific atrial models for clinical applications.
J. Bohnert, and O. Doessel. Simulations of temperature increase due to time varying magnetic fields up to 100 kHz. In IFMBE Proceedings, 2011[request PDF]
Abstract: Magnetic Particle Imaging (MPI) benefits from the non-linear magnetization curve of magnetic nano-particles. Magnetic fields applied in this new imaging modality are of fre- quencies in the kHz-range. Little research has been carried out upon absorbed power and temperature increase caused by time- varying fields in that frequency range. Presented here are tem- perature distributions in a human body model exposed to mag- netic fields of 10 kHz to 100 kHz. A numerical human model has been placed within field generating coils. The finite elements model for the field calculation and the Pennes Bio-heat equation for the temperature distribution with and without perfusion and heat transfer by convection have been used. The results indicate that the absorbed power does lead to local temperature increase but not up to a hazardous level, if certain thresholds for the mag- netic fields are considered.
Abstract: Atrial fibrillation (AF) is a common pathology. AF modifies the electrophysiological properties of cells (remodeling) promoting the occurrence and maintenance of AF.
Electrical remodeling includes changes in ICa,L, Ito, IK1 and IK,ACh. These effects were integrated in a human atrial computer model. Gap junction remodeling was considered in the conductivity of the monodomain equation calculating excitation. Specific features were calculated to determine the risk of AF initiation and perpetuation.
ERP was reduced from 330ms to 103ms. CV was lowered from 755mm/s to 608mm/s. The WL reduction was even higher (from 249mm to 63mm) leading to a higher probability of occurrence and maintenance of AF. A maximum of 7 spirals waves were initiated leading to a peak in the power spectrum at 10.32Hz.
The computer model underlines the relevance of remodeling in AF chronification. The results add to the knowledge of AF maintenance. Our model might prove to be a tool for the development of novel therapeutic strategies.
Abstract: Current models of the human atria represent geometries of single individuals or base on statistical data. We present a work-flow for the creation of patient-specific atrial models. Furthermore we show a framework to compare simulated P- waves and body surface potential maps (BSPMs) of individual patients with measurements. Models of the atrial and thorax anatomy were segmented from MRI data. Volumetric atrial models were semi-automatically enhanced with electrophys- iologically (EP) relevant structures. Simulations were performed on an anisotropic voxel-based mesh and were forward calculated to obtain simulated BSPMs. BSPMs were acquired using a 64 electrode ECG system. Comparison of simulated and measured P-waves in Einthoven leads showed a general agreement of both, although no personalization of the atrial electrophysiology model was performed. P-wave duration was longer in the simulations, highlighting the need for elec- trophysiological model personalization. Simulated and measured BSPMs revealed similar patterns. The presented method enables realistic simulations of atrial activation on patient-specific volumetric atrial models with EP relevant myocardial structures resulting in computed ECGs (P-wave) and BSPMs with show physiological morphologies
Abstract: Catheter ablation of atrial fibrillation (AF), especially persistent AF, is still challenging. The underlying mechanisms are not yet completely understood and are discussed very controversially. Automated detection and analysis of complex frac- tionated atrial electrograms is essential in supporting the electrophysiologists during ablation therapy. Signal analysis of atrial signals works better the less noise and unwanted signals superimpose the signal to be analysed. As for catheter ablation of persistent AF the atrial signals play the most important role, ventricular activity is unwanted to be seen. For catheter positions in close proximity to the ventricles, i.e. the coronary sinus catheter, those ventricular far fields are taint- ing the atrial signals. For this reason we present a method to cancel the ventricular far field from atrial electrograms. Atrial segments synchronized to the ventricular activity are extracted and the ventricular far field is cancelled by use of a PCA approach. Signal processing of the sole atrial electrogram leads to better results and therefore can better support the abla- tion therapy.
M. W. Keller, C. Schilling, A. Luik, C. Schmitt, and O. Dössel. Descriptors for a classification of complex fractionated atrial electrograms as a guidance for catheter ablation of atrial fibrillation. In Biomedizinische Technik / Biomedical Engineering, vol. 55(s1) , pp. 100-103, 2010[request PDF][doi]
Abstract: Atrial fibrillation (AFib) is a frequent and serious cardiac arrhythmia. A successful method to treat AFib is catheter ab- lation. Areas with complex fractionated atrial electrograms (CFAE) are ideal targets for catheter ablation. Concerning the ablation strategy and the search for CFAEs the physician is mainly dependent on his own judgment. For this reason ablation strategies are highly operator dependent. In this work a set of seven descriptors is presented which show promising results concerning a classification of measured atrial electrograms. The descriptors are evaluated on a database of 25 CFAE sig- nals. The results reveal a possible discrimination between CFAE classes which could be a valuable support for physicians curing AFib
T. Baas, H. Köhler, H. Malberg, and O. Dössel. Automatic blood pressure segmentation algorithm for analysing morphology changes. In Biomedizinische Technik / Biomedical Engineering (Proceedings BMT2010), vol. 55(1) , pp. 168-171, 2010[request PDF][doi]
Abstract: Simultaneous recording of ECG, Atrial Blood Pressure (ABP) and respiration is possible and sometimes done to investigate cardiovascular and respiration coupling. But analysis most often concentrates on Heart Rate Variability (HRV) and Blood Pressure Variability (BPV). Although analysis of HRV and BPV has lead to important clinical information in the past, an investigation of the morphology of the time course of ECG and ABP could reveal additional diagnostic information.
To analyse the morphology of the Blood Bressure (PB) wave a detection of characteristic points, outliers and boundaries is necessary. A wavelet based algorithm for blood pressure segmentation with outlier detection is presented in this paper. It is tested on 108 records with durations of 30 minutes each.
Abstract: There is a large interest in analysing the QT-interval, as a prolonged QT-interval can cause the development of ventricular tachyarrhythmias such as Torsade de Pointes. One major part of QT-analysis is T-end detection. Three automatic T-end delineation methods based on wavelet fil- terbanks (WAM), correlation (CORM) and Principal Com- ponent Analysis PCA (PCAM) have been developed and applied to Physionet QT database. All algorithms tested on Physionet QT database showed good results, while PCAM produced better results than WAM and CORM achieved best results. Standard de- viation in sampling points (fs=250Hz) have been 33.3 (WAM), 8.0 (PTDM) and 7.8 (CORM). It could be shown that WAM is prone to interference while CORM is the most stable method even under bad conditions. Further- more it was possible to detect significant QT-prolongation caused by Moxifloxacin in Thorough QT Study # 2 us- ing CORM. QT-prolongation is significantly correlated to blood plasma concentration of Moxifloxacin.
Abstract: Prolongation of the ECG QT-interval is a risk factor as it can cause the development of ventricular tachyarrhythmias such as Torsade de Points and ventricular fibrillation often leading to sudden cardiac death. Thus there is a large interest in analysing the QT-interval in the ECG. One major part of ECG QT-analysis is T-end detection. A method for automatic T-end detection is presented and validated by the Physionet QT-database. The delineation algorithm presented here is based on a correlation method. Results have been compared to hand marked T-waves in the Physionet QT-database. The algorithm produced significantly better results than using the standard wavelet method.
Abstract: During acute cardiac ischemia, electrophysiological properties of the affected tissue are altered in the subendocardium firstly. If the occlusion worsens, the effects spread transmurally. Diagnosis of cardiac ischemia, which should be improved by computer simulations, is based on shifts of the ST segment. In this work, we simulated heterogeneous ischemic regions with varying transmural extent. The excitation propagation and ECGs were calculated for the different setups. We showed that ST segment polarity can be dependent on the transmural extent of the ischemic region. In case of subendocardial ischemia, short action potentials were initiated in the ischemic zone causing a slight transmural gradient of the transmembrane voltage. Therefore, the ST segment was depressed in leads near the ischemic region in the chosen case. During transmural ischemia, this gradient showed in the opposite direction from epicardium to endocardium leading to ST segment elevation.
Abstract: The monodomain model is a mathematical description of the electrical excitation propagation in the heart. The numerical solution of this reaction-diffusion equation is a computationally demanding task. Aspects that have to be considered are the accuracy and stability of the solution on the one hand and the computing time on the other hand. Two first order methods – an explicit and a semi-implicit scheme – solving the monodomain equation were compared in this work. For the benchmark of the solvers, three cell models with different computational complexity were used. Thus, the contribution of the solvers to the total computing time could be analyzed. Generally, if the same time step was used, the semi-implicit was slower than the explicit one, since an additional linear system of equations had to be solved. However, the semi-implicit solver was more accurate and showed better stability behavior than the explicit one, especially at high spatial resolutions. Therefore, larger time steps could be used, achieving the same accuracy and a shorter total computing time as the explicit solver. However, this effect was present only, if the additional calculations of the semi-implicit solver contributed less to the total computing time, i.e. the cell model had to be computationally complex.
J. Bohnert, B. Gleich, J. Weizenecker, J. Borgert, and O. Doessel. Simulations of current densities and specific absorption rates in realistic magnetic particle imaging drive-field coils. In Biomedizinische Technik / Biomedical Engineering (Proceedings BMT2010), vol. 55(s1) , 2010[request PDF]
Abstract: Since the idea of Magnetic Particle Imaging (MPI) has been initially published in 2005, a lot of effort has been invested to improve temporal and spatial resolution. Most recently, first in vivo 3D real-time MPI scans were presented revealing details of a beating mouse heart [1]. In MPI, besides a strong time-constant field gradient, an alternating magnetic field of about 25 kHz frequency is applied to the patient. For the development of a new imaging technique, it is important to investigate the effects of the induced fields with respect to current densities and specific absorption rates (SAR) to ensure safe operation. This work presents simulations of the fields induced by a typical MPI laboratory setup and an MPI system scaled up to whole body dimensions.
J. Bohnert, and O. Dössel. Effects of time varying currents and magnetic fields in the frequency range of 1 kHz to 1 MHz to the human body - a simulation study. In Conf Proc IEEE Eng Med Biol Soc, pp. 6805-6808, 2010[request PDF]
Abstract: Exposure to time-varying magnetic fields evokes two effects in biological tissue: Firstly, an electric field is induced that generates eddy currents in conductive tissues, and, secondly, power deposit might increase local temperatures. Field effects of frequencies up to 1 kHz and above 1 MHz are well known. The intermediate frequency range lacks intensive research. Only little attention has been paid so far. Yet due to recent innovations in medical diagnostics and therapies like Magnetic Particle Imaging or RF-Hyperthermia, the need arises to investigate the frequency range from 1kHz to 1 MHz. This work presents results of numerical field calculations of a human body model placed within simple coil configurations. Induced current densities, generated by alternating coil currents, are simulated. The effect of current densities are demonstrated and evaluated on schematic cell models of excitable tissue. In order to generate an action potential at the cell membrane, a difference in electric potential from intra- to extracellular space must be present. It can be shown that in case of sufficient field strength, stimulation of nerves and muscles is possible up to a frequency of 100 kHz. The aim of this paper is to transfer simulation results from the macroscopic model to the microscopic model in order to estimate field effects of big field generating coils.
Abstract: Patients suffering from the congenital Long-QT syndrome have been reported to react highly sensitive to the presence of beta-adrenergic agents that are produced by the sympathetic nervous system. In this work we used an anisotropic and electrophysiologically heterogeneous in- silico model to reproduce wedge experiments in which the Long-QT syndrome was induced pharmacologically. The integration of an intracellular signaling cascade allowed the prediction of the effects of adrenergic agents on the different subtypes of the Long-QT syndrome. For LQT1 the in-silico model predicted a QT prolongation in the transmural pseudo ECG without an increase in transmural dispersion of repolarization. For LQT2 and LQT3 the QT prolongation was accompanied by an increased transmural dispersion of repolarization. beta-adrenergic tonus shortened the QT interval and increased transmural dispersion of repolarization. These findings were consistent with the experimental reports.
O. Jarrousse, T. Fritz, and O. Dössel. Modeling breast tissue mechanics from Prone to supine positions with a modified mass-spring system. In Proceedings BMT 2010, 44. DGBMT Jahrestagung, 3-Länder-Tagung D-A-CH, Rostock, vol. 55(S1) , pp. 87-90, 2010[request PDF]
Abstract: A volumetric mass-spring system, originally developed for myocardial mechanics modeling [1], is used to simulate the elasto-mechanical deformation of several breast datasets from prone to supine positions. Segmented MRI datasets of pa- tients in prone position, available from the online repository provided by Susan C. Hagness at the University of Wisconsin- Madison [2] were used in the biomechanical simulations. These models were considered to be consisting of two materi- als, fat and fibroconnective/glandular tissues. Each tissue is represented as a nearly incompressible Neo-Hookean elastic isotropic material. Each simulation was conducted in two steps: in the first step, the unloaded model is generated by apply- ing gravity forces to the original model pointing toward the body. The unloaded model is then used in the second step, by applying gravity forces. Eventually, the breast model in supine position is obtained.
D. U. J. Keller, O. Dössel, and G. Seemann. Evaluation of rule-based approaches for the incorporation of skeletal muscle fiber orientation in patient-specific anatomies. In Proceedings Computers in Cardiology, vol. 36, pp. 181-184, 2009[request PDF]
Abstract: Muscle anisotropy is important for the realistic solution of the forward problem of electrocardiography. Whenever computer models of patient-specific anatomies are created usually no information about the muscle fiber arrangement in the heart or skeletal muscle is available. As in-vivo imaging techniques that can determine fiber orientation like Diffusion Tensor MRI are time-consuming and susceptible to motion artifacts, cardiac fiber orientation is frequently described using simplified rules. However, for the skeletal muscle there are only few suggestions for a rule-based implementation of fiber orientation into patient-specific models. In this work we evaluated a rule-based approach from the literature together with two new methods by comparing the corresponding forward calculated body surface potential maps (BSPMs) with the BSPM resulting from a reference skeletal muscle fiber distribution extracted from the thin-section photos of the Visible Man dataset (Journal of Computing and Information Technology vol.6, pp. 95-101 1998). The skeletal muscle anisotropy ratio was set to 3:1. The following fiber orientation setups were evaluated: A) the torso is divided into twelve sectors (cross-section perspective) and fiber direction was assumed to be perpendicular to the bisector as proposed by Klepfer et al. (IEEE Trans. Biomed. Eng. vol. 44, no. 8, pp. 706-719 1997); B) A 3D Sobel filter was used on the torso geometry filled with a gradient from inside to outside which generated a vector that was normal to the thoracic surface in every voxel. Fiber orientation was assumed to be perpendicular to the plane formed by these normal vectors and the direction from head to feet (longitudinal torso orientation); C) Same procedure as in B) but additionally, the back muscles which are known to have a longitudinal orientation were integrated accordingly. Potentials were extracted at 64 electrode positions from the BSPMs. The RMS was calculated at these electrode positions between the reference fiber distribution and the respective rule-based approaches. The RMS was comparable between A) and B) (8.8e-5 vs. 8.9e-5) leading to the conclusion that the twelve discrete sectors introduced no significant error. A) and B) performed also well compared to a modified version of the reference dataset where the longitudinal component of the fiber vectors was set to zero (8.3e-5). Including the longitudinal components of the back muscles as done in C) enhances the RMS to 5.5e-5. If the skeletal muscle anisotropy was neglected and only cardiac fiber orientation was taken into account, the RMS improved (!) further to only 4.0e-5. Thus it can be concluded that neglecting the longitudinal component (A) and B)) or accounting for it with a highly simplified approach (C)) is not sufficient. In cases where no detailed information about the skeletal muscle fiber arrangement is available, it is better to entirely neglect its anisotropic influence.
O. Jarrousse, T. Fritz, and O. Dössel. Implicit time integration in a volumetric mass-spring system for modeling myocardial elastomechanics. In IFMBE Proceedings World Congress on Medical Physics and Biomedical Engineering, vol. 25/4, pp. 876-879, 2009[request PDF]
Abstract: A modified mass-spring system for simulating the passive and active elastomechanical properties of the myocardial tissue was presented in a previous publication. The previously presented results are combined with the method also published earlier to use continuum mechanics calculate passive forces in a mass-spring system directly starting from the energy density function of the stress-strain relation. An efficient method for volume preservation is presented and the implementation of an implicit time integration method for solving the system’s equations of motion is described. The computational complexity of the system is analyzed and shown to be of O(n). At the end several simulations are conducted to demonstrate the method.
M Grafmüller, SA Seitz, and O Dössel. Adaption of generic anatomic organ models on patient specific data sets. In IFMBE Proceedings World Congress on Medical Physics and Biomedical Engineering, vol. 25(4) , pp. 884-887, 2009[request PDF]
Abstract: Anatomical voxel models are used for example for dosimetric assessment and numerical field calculations. For best matching between model’s and patient’s properties an accurate model should be created by Magnetic Resonance Imaging or Computer Tomography images for every patient. Due to complexity, time and costs this is not always possible. In contrast 3D laser scanning is a fast and easy method to gain information about a patient’s body surface. In this work generic organ models are developed to fit into the laser scan envelope of any patient. One model set was processed as to fit to the volume reference values of the International Commission on Radiological Protection’s of six different ages. To accomplish a more realistic shape, orthogonal scaling factors are used to simulate growth in three different directions.
Abstract: Patient-specific model adaptation and validation requires a comparison of simulations with measured patient data. For patients suffering from atrial fibrillation, such data is mainly available as intracardiac catheter signals. In this work, we demonstrate the simulation of clinically relevant catheter data as measured using circular mapping catheters (such as Lasso or Orbiter) and coronary sinus catheters using atrial simulations on a realistic geometry. Four circular catheters are modeled using a projection technique for two distinct types of application. We show that in sinus rhythm, the choice of a distinct electrophysiological model does not impair the signal quality. Finally, we compare simulated potentials to a real clinical measurement. In the future, with patient- specific models available, such comparisons can constitute an important interface for personalizing cardiac models.
A. Luik, C. Schilling, M. Merkel, O. Dössel, and C. Schmitt. Effect of Pulmonary Vein Isolation on the mean Fractionation and the mean dominant Frequency of the left atrium in Patients with Persistent Atrial Fibrillation. In Heart Rhythm, vol. 6(5S) , pp. 153, 2009[request PDF]
D. U. J. Keller, R Kalayciyan, O Dössel, and G Seemann. Fast creation of endocardial stimulation profiles for the realistic simulation of body surface ECGs. In IFMBE Proceedings World Congress on Medical Physics and Biomedical Engineering, vol. 25/4, pp. 145-148, 2009[request PDF]
Abstract: The Purkinje network plays a major role for realistically simulating the activation sequence of the ventricles. In this work, we describe a method to create an endocardial stimulation profile that describes the location and time instant of ventricular stimulation, thus mimicking the His-Purkinje conduction system. By adapting model parameters stimulation profiles can be generated for different ventricular anatomies with minimal manual interaction. The stimulation profile parameters are evaluated by analyzing the excitation propagation in a three-dimensional, heterogeneous and anisotropic model of the human ventricles which are embedded in an anatomically detailed torso geometry. The calculated QRS complexes are in good agreement with the corresponding clinical recordings on the same proband.
Abstract: The curative therapy of atrial fibrillation (AF) is still challenging. Although the electrophysiologists know many strategies to cure AF, the underlying mechanisms are still mostly unknown. Also the optimal ablation strategy for paroxysmal and long-lasting persistent AF is not known. Complex fractionated atrial electrograms (CFAEs) are becoming more and more important in the ablation strategies, especially for long-lasting persistant AF. Automated detection and signal analysis of CFAEs is essential in supporting the physicians during the ablation procedure. The robust algorithm to locate CFAEs presented in the contribution by Nguyen, Schilling and Dössel delivers a good bases for postprocessing and signal analysis of CFAEs. It is employing a non-linear energy operator combined with thresholding. In this paper this new algorithm is tested on clinical data and compared to clinically accepted algorithms.
Y. Jiang, C. Qian, R. Hanna, D. Farina, and O. Dössel. Optimization of the electrode positions of multichannel ECG for the reconstruction of ischemic areas by solving the inverse electrocardiographic problem. In Proc. the 7th International Symposium on Noninvasive Functional Source Imaging of the Brain and Heart and the International Conference on Functional Biomedical Imaging, 2009[request PDF]
Y. Jiang, W. Hong, D. Farina, and O. Dössel. Solving the inverse problem of electrocardiography in a realistic environment using a spatio-temporal LSQR-Tikhonov hybrid regularization method. In IFMBE Proceedings World Congress on Medical Physics and Biomedical Engineering, vol. 25/2, pp. 817-820, 2009[request PDF]
Y. Jiang, C. Qian, R. Hanna, D. Farina, and O. Dössel. Optimization of electrode positions of a wearable ECG monitoring system for efficient and effective detection of acute myocardial infarction. In Proc. Computers in Cardiology, 2009[request PDF]
Y. Jiang, Y. Meng, D. Farina, and O. Dössel. Effect of respiration on the solutions of forward and inverse electrocardiographic problems - a simulation study. In Proc. Computers in Cardiology (Rosanna Degani Young Investigator Award Nomination), 2009[request PDF]
Abstract: Intracardiac catheter recordings are available in common clinical practice. They can therefore be employed to adapt and validate atrial computer models of individual patients. Hence, their information content needs to be analyzed quantitatively. During treatment of atrial arrhythmia such as atrial flutter or fibrillation, the location of ectopic foci in the pulmonary veins is of special interest. In this study, virtual catheter signals are extracted from an atrial simulation on a realistic geometry with normal sinus rhythm as well as ectopic stimuli in all four pulmonary veins. Using a simplified Pan-Tompkins algorithm, the activation times are determined. Based on the analysis of the activation sequence in a circular mapping catheter simulated on the posterior left atrial wall, all four ectopic foci can clearly be associated with the pulmonary vein they came from. For a catheter on the anterior wall, this is possible for three of the four ectopic beats. Despite the knowledge gathered for the personalization of patient models, such simulations may help cardiologists to better classify measured signals.
Abstract: Magnetic Particle Imaging (MPI) is a new tomographic imaging technique based on magnetization of ferromagnetic nano-particles. Magnetic fields of different strengths and frequencies generate and move a field free point (FFP) over the field of view, inducing a signal of the magnetic particles, if present. The magnetic fields induce current densities of high amplitude in the patient’s body and deposit an amount of power that might lead to painful warming in the patient’s periphery. Based on the specifications of the MPI system, an optimized coil configuration is suggested here, reducing high peak values of current densities and specific absorption rate (SAR), by running the field generating coils of different radius with optimized currents. The results presented here are based on numerical field calculations with a simple cylindrical model, used for the optimization procedure, and the Visible Man data-set, for evaluating the optimization results.
SA Seitz, and O Dössel. Electromagnetic Fields near Implanted Cardiac Devices during Magnetic Resonance Imaging. In IFMBE Proceedings World Congress on Medical Physics and Biomedical Engineering, vol. 25/2, 2009[request PDF]
S. A. Seitz, and O. Dössel. Numerical modeling of current distribution in and near the tips of cardiac pacemaker electrodes during magnetic resonance imaging. In Proc. Computers in Cardiology, 2009[request PDF]
Abstract: Magnetic Resonance Imaging (MRI) is a widely used means of imaging and becoming increasingly popular for cardiac applications as well. But for patients with im- planted pacemakers, the use of MRI is not allowed in Eu- rope and the United States due to potentially hazardous interactions of the RF pulses with the pacemaker-electrode system. Here heating at the tip of the electrode is regarded as the most important one.
In this simulation study, the occurring current densities and E-fields should be determined by employing numerical field calculation. Computer models of metallic objects like straight wires, simplified pacemakers and a replication a commercial bipolar electrode were placed in a plexiglas box positioned inside a birdcage coil. The results con- firmed findings of previous in-vitro studies regarding the influence of size and position of the exposed objects and thereby proved the validity of the presented approach.
SA Seitz, and O Dössel. Influence of body worn wireless mobile devices on implanted cardiac pacemakers. In 4th European Congress for Medical and Biomedical Engineering, vol. 22, 2008[request PDF]
Abstract: The number of implanted cardiac pacemakers and defibrillators is constantly increasing. At the same time, more and more of those patients use wireless mobile communication devices.
Aim of this work was the development of a pacemaker-electrode model and its “implantation” into a detailed anatomical correct voxel model. Additionally generic body models were examined. It consists of several layers with varying thickness and conductivity/permittivity values corresponding to different tissue types. This approach was chosen to avoid numerical errors at tilted boundaries. The excitation sources were modeled as generic dipoles and as plane waves operating at the frequency range normally used by cellular phones and wireless networks (900 to 2450 MHz). The dipoles were designed to provide maximum radiation efficiency at the frequencies of interest. Finally numerical calculation of induced fields by external signal sources were conducted. The results were then evaluated regarding the compliance to the guidelines of ICNIRP and a draft by DIN/VDE.
For the Visible Man model, the computed specific absorption rate (SAR) values were well below the thresholds both for single and multi-antenna setups and for all frequencies of interest if the power did not exceed the regulatory specifications. The same results were obtained for the electrical field values determined at commonly used implantation sites for pacemakers. For some tissue configurations in the generic model, higher SAR values than allowed by regulations could be observed.
Y. Jiang, D. Farina, and O. Dössel. Localization of the origin of ventricular premature beats by reconstruction of electrical sources using spatio-temporal MAP-based regularization. In Proc. 4th European Conference of the International Federation for Medical and Biological Engineering, vol. 22, pp. 2511-2514, 2008[request PDF]
Abstract: Ventricular premature beats (VPB) occur when a cardiac depolarization is initiated from a focus in the ventricle instead of the sinoatrial node. Because the ventricular electrical excitation is not started from the intraventriclular conduction system, the excitation propagation in the ventricles behaves in an abnormal manner. This results in an extra asynchronous contraction of the ventricles. In addition VPBs can trigger life-threatening heart arrhythmias. Applying catheter ablation can cure VPB. Therefore it is of importance to localize the origin of VPB using a non-invasive approach before interventional treatment. In this work the inverse problem of electrocardiography is deployed to reconstruct electrical sources in the ventricles, from which the origin of VPB can be identified. By using a spatiotemporal maximum a posteriori (MAP) based regularization the quality of reconstructions is improved. In this work forward calculations with various VPBs are employed to construct a statistical a priori information.
Y. Jiang, D. Farina, and O. Dössel. Effect of heart motion on the solutions of forward and inverse electrocardiographic problem - a simulation study. In Proc. Computers in Cardiology, pp. 365-368, 2008[request PDF]
Abstract: Solving the forward problem of electrocardiography provides a better understanding of electrical activities in the heart. The inverse problem of electrocardiography enables a direct view of cardiac sources without catheter interventions. Today the forward and inverse computation is most often performed in a static model, which doesn't take into account the heart motion and may result in considerable errors in both forward and inverse solutions. In this work a dynamic heart model is developed. With this model the effect of the heart motion on the forward and inverse solutions is investigated.
Abstract: Simulation of cardiac excitation is often a trade-off between accuracy and speed. A promising minimal, time-efficient cell model with four state variables has recently been presented together with parametrizations for ventricular cell behaviour. In this work, we adapt the model parameters to reproduce atrial excitation properties as given by the Courtemanche model. The action potential shape is considered as well as the restitution of action potential duration and conduction velocity. Simulation times in a single cell and a tissue patch are compared between the two models. We further present the simulation of a sinus beat on the atria in a realistic 3D geometry using the fitted minimal model in a monodomain simulation.
T. Fritz, O. Jarrousse, and O. Dössel. Adapting a mass-spring system to energy density function describing myocardial mechanics. In Proceedings of the 4th European Congress for Medical and Biomedical Engineering 2008. 23-27 November 2008, Antwerp, Belgium, vol. 22, pp. 2003-2006, 2008[request PDF]
Abstract: Numerous studies about the effects in human body of high frequency magnetic fields on the one hand and extremely low frequency fields on the other hand have been carried out. This is not the case for the mid frequency range around 100 kHz. When applying external magnetic fields to the human body in this frequency range both electric stimulation and thermal heating effects have to be considered. Magnetic Particle Imaging (MPI), a new imaging technique, and Hyperthermia, a tumor treatment therapy, both apply magnetic fields in a frequency range around 100 kHz. In MPI thermal heating of the body has to be prevented, whereas in Hyperthermia a temperature increase of about 4 K in the target region is desirable. Induced currents may lead to muscle stimulation which is not acceptable above a certain threshold.
This paper presents the results of induced current densities and SAR in a numeric field calculation simulation. For the model of the human body the torso of the Visible Man Dataset has been employed, along with the dielectric properties of biological tissues investigated by Gabriel & Gabriel. The model has been exposed to a sinusoidal magnetic field with an amplitude of 10 mT. The results of the induced current densities and SAR values have been compared with the currently valid official guidelines for limiting exposure to time-varying electric, magnetic and electromagnetic fields by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). It turns out that limits of induced current densities are reached by applying a magnetic flux density of 10 mT and the SAR limit even is exceeded.
SA Seitz, G Seemann, and O Dössel. Influence of tissue anisotropy on the distribution of defibrillation fields. In Proc. Computers in Cardiology, pp. 489-492, 2008[request PDF]
Abstract: The development of new devices used for defibrillation and cardioversion is often supported by numerical simulations of the induced electric potentials and current distributions. The commonly used tools incorporate isotropic models of the tissue properties present in the human torso. A comparative study was conducted to characterize the influence of anisotropic compared to isotropic tissue modeling. Defibrillation shocks with amplitudes of 1000 V and 2000 V were simulated and a set of varying conductivity values and anisotropy ratios was examined. The inclusion of tissue anisotropy produced significantly smaller values for current density compared to isotropic calculations especially in the myocardial tissue.
Abstract: The modelling of the relationship between QT and RR intervals is an important issue for pharmaceutical
research on the way to new drugs. Pharmaceutical industries have to thoroughly investigate potential effects of their medicines on QT intervals since QT prolongation is considered as a marker of the proarrhythmia risk. As QT intervals depend on RR intervals there is an obvious interest in modelling the QT-RR relationship. Static formulas to correct QT for RR are well known, but a dynamic dependency
is mainly observed.
Two models of dynamic QT-RR relationships are introduced to eliminate the heart rate dependent part out of the QT interval. These models are based on heart cell measurements and simulations and are validated by Holter ECG data.
O. Jarrousse, T. Fritz, and O. Dössel. A modifed mass-spring system for myocardial mechanics modeling. In Proceedings of the 4th European Congress for Medical and Biomedical Engineering 2008. 23-27 November 2008, Antwerp, Belgium, vol. 22, pp. 1943-1946, 2008[request PDF]
Abstract: The congenital long-QT syndrome is commonly associated with a high risk for polymorphic ventricular tachy-cardia and sudden cardiac death. This is probably due to an intensification of the intrinsic heterogeneities present in ventricular myocardium. Increasing the electrophysiological heterogeneities amplifies the dispersion of repolarization which directly affects the morphology of the T wave in the ECG. The aim of this work is to investigate the effects of LQT2, a specific subtype of the long-QT syndrome (LQTS), on the Body Surface Potential Maps (BSPM) and the ECG. In this context a three-dimensional, heterogeneous model of the human ventricles is used to simulate both physiological and pathological excitation propagation. The results are used as input for the forward calculation of the BSPM and ECG. Characteristic QT prolongation is simulated correctly. The main goal of this study is to prepare and evaluate a simulation environment that can be used prospectivley to find features in the ECG or the BSPM that are characteristic for the LQTS. Such features might be used to facilitate the identification of LQTS patients.
D. U. J. Keller, D. L. Weiss, O. Dössel, and G. Seemann. Transferring ventricular myocyte orientation to individual patient data based on diffusion tensor MRI measurements. In Tagungsband 6. Jahrestagung der Deutschen Gesellschaft für Computer- und Roboterassistierte Chirurgie e. V., pp. 255-258, 2007[request PDF]
G. Seemann, D. L. Weiß, F. B. Sachse, and O. Dössel. Electrophysiology and Tension Development in a Transmural Heterogeneous Model of the Visible Female Left Ventricle. In Lecture Notes in Computer Science, vol. 3504, pp. 172-182, 2005[request PDF]
Persönliches / CV
Curriculum Vitae
17.08.1954
geboren in Lübeck
1973
Abitur in Lübeck Physikstudium an der Christian-Albrechts-Universität Kiel
1979
Diplom in Physik Assistent am Institut für Experimentalphysik der Universität Kiel bei Prof. Dr. Ruprecht Haensel, Promotionsstipendium der Studienstiftung des deutschen Volkes
1982
Promotion zum Dr. rer. nat. mit einer Arbeit zum Thema „Lumineszenz fester Edelgase"
1982
Wissenschaftlicher Assistent am Philips Forschungslaboratorium Hamburg, Thema: Druck- und Kraft-Sensoren
1985
Leiter der Forschungsgruppe Messtechnik am Philips Forschungslaboratorium Hamburg, Thema: Supraleitende Sensoren und Biomagnetismus
1996
Ruf auf den Lehrstuhl für Medizintechnik an der Universität Karlsruhe, Leiter des Instituts für Biomedizinische Technik Thema: Herzmodelle und bioelektrische Signale des Herzens
