Computer assisted optimization of cardiac resynchronization therapy

In this research project, biventricular pacing (BVP) as cardiac resynchronization therapy is optimized by using computer based heart models individualized to the patient in terms of anatomy and pathophysiology. An optimized BVP is expected to provide a significant improvement of patient’s hemodynamic parameters by increasing cardiac output in patients suffering from left bundle branch block (LBBB) and cardiac contraction dyssynchrony.
The project includes generation of anatomical and pathophysiological models of the patient’s heart and subsequent validation of the optimization results obtained. The individual models are generated by segmentation of high-resolution imaging techniques (MRI, CT) in order to obtain the patient’s anatomy. The model of the left ventricle is subdivided into 17 segments according to the American Heart Association (AHA) suggestion, which simplifies the determination of myocardial infarction positions in accordance with corresponding coronary artery.
Multichannel ECG measurements are carried out in order to gain the individual patient excitation parameters by solution of the inverse problem. The pathophysiological models representing the patient’s pathology in addition with the parameters obtained from the inverse problem are implemented into the anatomical models. Hence, accurate simulation of excitation propagation is enabled.
By using this detailed model, an individual optimization of BVP with respect to pacing electrode positioning and timing delays is achieved.
The results of optimization are validated by multichannel ECG or stroke volume measurements in clinical studies performed in cooperation with the University Hospital Heidelberg.