Noninvasive, automatic optimization strategy in cardiac resynchronization therapy.
OBJECTIVE: Optimization of cardiac resynchronization therapy (CRT) is still unsolved. It has been shown that optimal electrode position,atrioventricular (AV) and interventricular (VV) delays improve the success of CRT and reduce the number of non-responders. However, no automatic, noninvasive optimi...
| Publicado en: | Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi Vol. 7; pp. 209 - 213 |
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| Autores principales: | , , |
| Formato: | research Journal Article |
| Publicado: |
KARE Publishing
Jul2007 Supplement
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106006361&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106006361 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 21492263 1XEB jtl: Anatolian Journal of Cardiology / Anadolu Kardiyoloji Dergisi issn: 21492263 maglogo: N pubinfo: dt: Jul2007 Supplement vid: 7 pid: 62027 pub: KARE Publishing artinfo: ui: 106006361 106006361 2009629861 NLM17584727 106006361 ppf: 209 ppct: 4 formats: tig: atl: Noninvasive, automatic optimization strategy in cardiac resynchronization therapy. aug: au: Reumann M Osswald B Doessel O affil: Computational Biology Center, IBM TJ Watson Research Center, 1101 Kitchawan Road, Route 136, Yorktown Heights, NY 10598; mreumann@ieee.org sug: subj: Bundle-Branch Block Therapy Cardiac Resynchronization Therapy Computer Simulation Defibrillators, Implantable Human ab: OBJECTIVE: Optimization of cardiac resynchronization therapy (CRT) is still unsolved. It has been shown that optimal electrode position,atrioventricular (AV) and interventricular (VV) delays improve the success of CRT and reduce the number of non-responders. However, no automatic, noninvasive optimization strategy exists to date. METHODS: Cardiac resynchronization therapy was simulated on the Visible Man and a patient data-set including fiber orientation and ventricular heterogeneity. A cellular automaton was used for fast computation of ventricular excitation. An AV block and a left bundle branch block were simulated with 100%, 80% and 60% interventricular conduction velocity. A right apical and 12 left ventricular lead positions were set. Sequential optimization and optimization with the downhill simplex algorithm (DSA) were carried out. The minimal error between isochrones of the physiologic excitation and the therapy was computed automatically and leads to an optimal lead position and timing. RESULTS: Up to 1512 simulations were carried out per pathology per patient. One simulation took 4 minutes on an Apple Macintosh 2 GHz PowerPC G5. For each electrode pair an optimal pacemaker delay was found. The DSA reduced the number of simulations by an order of magnitude and the AV-delay and VV - delay were determined with a much higher resolution. The findings are well comparable with clinical studies. CONCLUSION: The presented computer model of CRT automatically evaluates an optimal lead position and AV-delay and VV-delay, which can be used to noninvasively plan an optimal therapy for an individual patient. The application of the DSA reduces the simulation time so that the strategy is suitable for pre-operative planning in clinical routine. Future work will focus on clinical evaluation of the computer models and integration of patient data for individualized therapy planning and optimization. pubtype: Academic Journal doctype: research Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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