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The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.

ABSTRACT: Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure, however the effective selection of patients and optimisation of therapy remain controversial. While extensive research is ongoing, it remains unclear whether improvements in patient selection or therapy planning offers a greater opportunity for the improvement of clinical outcomes. This computational study investigates the impact of both physiological conditions that guide patient selection and the optimisation of pacing lead placement on CRT outcomes. A multi-scale biophysical model of cardiac electromechanics was developed and personalised to patient data in three patients. These models were separated into components representing cardiac anatomy, pacing lead location, myocardial conductivity and stiffness, afterload, active contraction and conduction block for each individual, and recombined to generate a cohort of 648 virtual patients. The effect of these components on the change in total activation time of the ventricles (?TAT) and acute haemodynamic response (AHR) was analysed. The pacing site location was found to have the largest effect on ?TAT and AHR. Secondary effects on ?TAT and AHR were found for functional conduction block and cardiac anatomy. The simulation results highlight a need for a greater emphasis on therapy optimisation in order to achieve the best outcomes for patients.

SUBMITTER: Crozier A

PROVIDER: S-EPMC4915816 | biostudies-other | 2016 Jul

REPOSITORIES: biostudies-other

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The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.

Crozier Andrew A Blazevic Bojan B Lamata Pablo P Plank Gernot G Ginks Matthew M Duckett Simon S Sohal Manav M Shetty Anoop A Rinaldi Christopher A CA Razavi Reza R Smith Nicolas P NP Niederer Steven A SA

Journal of molecular and cellular cardiology 20151104

Cardiac resynchronisation therapy (CRT) is an established treatment for heart failure, however the effective selection of patients and optimisation of therapy remain controversial. While extensive research is ongoing, it remains unclear whether improvements in patient selection or therapy planning offers a greater opportunity for the improvement of clinical outcomes. This computational study investigates the impact of both physiological conditions that guide patient selection and the optimisatio ...[more]

PMID: 26546827

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Project description:Study hypothesis:We sought to investigate the association between echocardiographic optimisation and ventricular activation time in cardiac resynchronisation therapy (CRT) patients, obtained through the use of electrocardiographic mapping (ECM). We hypothesised that echocardiographic optimisation of the pacing delay between the atrial and ventricular leads-atrioventricular delay (AVD)-and the delay between ventricular leads-interventricular pacing interval (VVD)-would correlate with reductions in ventricular activation time. Background:Optimisation of AVD and VVD may improve CRT patient outcome. Optimal delays are currently set based on echocardiographic indices; however, acute studies have found that reductions in bulk ventricular activation time correlate with improvements in acute haemodynamic performance. Materials and methods:Twenty-one patients with established CRT criteria were recruited. After implantation, patients underwent echo-guided optimisation of the AVD and VVD. During this procedure, the participants also underwent noninvasive ECM. ECM maps were constructed for each AVD and VVD. ECM maps were analysed offline. Total ventricular activation time (TVaT) and a ventricular activation time index (VaT10-90) were calculated to identify the optimal AVD and VVD timings that gave the minimal TVaT and VaT10-90 values. We correlated cardiac output with these electrical timings. Results:Echocardiographic programming optimisation was not associated with the greatest reductions in biventricular activation time (VaT10-90 and TVaT). Instead, bulk activation times were reduced by a further 20% when optimised with ECM. A significant inverse correlation was identified between reductions in bulk ventricular activation time and improvements in LVOT VTI (p < 0.001), suggesting that improved ventricular haemodynamics are a sequelae of more rapid ventricular activation. Conclusions:EAM-guided programming optimisation may achieve superior fusion of activation wave fronts leading to improvements in CRT response.

Dataset Information

The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.

Publications

The relative role of patient physiology and device optimisation in cardiac resynchronisation therapy: A computational modelling study.

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