Abstract
Mathematical models of the human heart are evolving to become a cornerstone of precision medicine and support clinical decision making by providing a powerful tool to understand the mechanisms underlying pathophysiological conditions. In this study, we present a detailed mathematical description of a fully coupled multi-scale model of the human heart, including electrophysiology, mechanics, and a closed-loop model of circulation. State-of-the-art models based on human physiology are used to describe membrane kinetics, excitation-contraction coupling and active tension generation in the atria and the ventricles. Furthermore, we highlight ways to adapt this framework to patient specific measurements to build digital twins. The validity of the model is demonstrated through simulations on a personalized whole heart geometry based on magnetic resonance imaging data of a healthy volunteer. Additionally, the fully coupled model was employed to evaluate the effects of a typical atrial ablation scar on the cardiovascular system. With this work, we provide an adaptable multi-scale model that allows a comprehensive personalization from ion channels to the organ level enabling digital twin modeling.
Highlights
The passive increase in volume and the atrio-ventricular plane displacement (AVPD) resulted in the atria being stretched by the ventricles, prolonging the time of contraction of the atria
We propose a framework for the fully coupled cardiac electro-mechanical problem with a detailed description of appropriate boundary conditions such as a lumped parameter model of the human circulatory system and a contact handling that replicates the effects of the tissue surrounding the heart
We provide parameterizations of a fully coupled excitation contraction model for cells of the atrial and ventricular myocardium
Summary
On the microscopic or cellular level, the reaction part was first described by Hodgkin and Huxley [9], while the diffusion on the macroscopic level can be modeled as described in [10] Another essential component of the mechanistic model is cardiac mechanics (M) to describe the deformation, and the interplay between these systems described by myofilament models to drive the contraction and relaxation of the myocardium. The latter depends on the loading conditions imposed by the circulatory system, which is most accurately described by a fluid-structure interaction (FSI) problem, and the tissue that is surrounding the heart. Most simulations of the coupled EP-M problem focus on (bi-)ventricular models of a single heart beat and only require isolated ventricular pre- and afterload models such as a 3- or 4-element
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