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Effects of the purkinje system and cardiac geometry on biventricular pacing: a model study

机译：Purkinje系统和心脏几何形状对双心室起搏的影响：模型研究

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Heart failure leads to gross cardiac structural changes. While cardiac resynchronization therapy (CRT) is a recognized treatment for restoring synchronous activation, it is not clear how changes in cardiac shape and size affect the electrical pacing therapy. This study used a human heart computer model which incorporated anatomical structures such as myofiber orientation and a Purkinje system (PS) to study how pacing affected failing hearts. The PS was modeled as a tree structure that reproduced its retrograde activation feature. In addition to a normal geometry, two cardiomyopathies were modeled: dilatation and hypertrophy. A biventricular pacing protocol was tested in the context of atrio-ventricular block. The contribution of the PS was examined by removing it, as well as by increasing endocardial conductivity. Results showed that retrograde conduction into the PS was a determining factor for achieving intraventricular synchrony. Omission of the PS led to an overestimate of the degree of electrical dyssynchrony while assessing CRT. The activation patterns for the three geometries showed local changes in the order of activation of the lateral wall in response to the same pacing strategy. These factors should be carefully considered when determining lead placement and optimizing device parameters in clinical practice.
机译：心力衰竭导致严重的心脏结构改变。尽管心脏再同步疗法（CRT）是恢复同步激活的公认疗法，但尚不清楚心脏形状和大小的变化如何影响电起搏疗法。这项研究使用了人类心脏计算机模型，该模型结合了诸如肌纤维方向和Purkinje系统（PS）的解剖结构，以研究起搏如何影响衰竭的心脏。 PS被建模为树状结构，再现了其逆行激活功能。除了正常的几何形状，还对两种心肌病进行了建模：扩张和肥大。在房室传导阻滞的情况下测试了双心室起搏协议。通过除去PS以及增加心内膜电导率来检查PS的贡献。结果表明，逆行传导进入PS是实现心室内同步的决定性因素。省略PS会导致在评估CRT时电气不同步的程度过高。响应相同的起搏策略，这三个几何形状的激活模式显示了侧壁激活顺序的局部变化。在临床实践中确定导线放置和优化设备参数时，应仔细考虑这些因素。

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