A personalized real-time virtual model of whole heart electrophysiology

Figures

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  FIGURE 1. Setup of the torso and whole heart EP simulations. (A) Tissue labels present within the model. Blood pools within the heart are not visualized. All electrodes for 12 lead ECG are recovered from the MRI image of the subject, with RL electrode serving as electrical ground. (B) Anatomical structures pertaining to cardiac EP. Structures of SAN block (SAN-B), pectinate muscles (PM), and CT are assigned generic EP. The AVN and the SAN facilitate activation, where the BB is assigned a higher CV to facilite coordinate activation of the atria. Each terminal cable before a root site is applied a different CV to control activation timings of the fascicles of the HPS. (C) Prescribed τ close parameters of the Mitchell-Schaeffer model needed to facilitate a physiological T-wave. Values within the ventricles are computed from the Eikonal activation map. Both atrial tissues and the HPS are assigned the maximal value. Isolines and binning of the color bar indicates 5 ms.

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  FIGURE 2. Activation and repolarization patterns during normal sinus rhythm underlying simulated ECGi information of BSPMs and EGMs. (A) Activation initiates from fascicular root sites and spreads into the fast-conducting Purkinje network. Latest activation is seen on the posterior RV free wall. (B) Repolarization is linearly dependent on activation, thus exhibiting a similar pattern. (C) The BSPM and EAM are visualized at a time point of 275 ms. Electrical potentials at 6 recording locations on the torso, on the epicardium, and in the blood pool next to the endocardium are shown for the single heart beat.

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  FIGURE 3. Simulated 12 lead ECGs of a single heartbeat. (A) The personalized heartbeat (red) during normal sinus rhythm is compared to an average heart beat in the measured data (black). Gray indicates 2 standard deviations from the average measured signal. Disease pathologies of (B) LBBB and (C) RBBB are compared to the simulated 12 lead ECG under sinus rhythm. The simulated and measured signals under sinus rhythm have a QRS duration of 85 ms. Simulated LBBB ECGs have QRS durations of 127 and 178 ms with a ...longitudinal CV of 0.6 m/s and 0.3 m/s, respectively, within the LV. Simulated RBBB ECGs have QRS durations of 121 and 148 ms with a longitudinal CV of 0.6 m/s and 0.3 m/s, respectively, within the RV.

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  FIGURE 4. Time-course of the transmembrane voltage within the heart for sinus rhythm and BBBs with both normal and halfed CV in the respective affected ventricle. Green isosurfaces within the ventricles correspond to a membrane voltage of −40 mV and the color map corresponds to the atrial trans-membrane voltages.