Abstract
The objectives of this study were to evaluate the accuracy of personalized numerical simulations of the electrical activity in human ventricles by comparing simulated electrocardiograms (ECGs) with real patients' ECGs and analyzing the sensitivity of the model output to variations in the model parameters. We used standard 12-lead ECGs and up to 224 unipolar body-surface ECGs to record three patients with cardiac resynchronization therapy devices and three patients with focal ventricular tachycardia. Patient-tailored geometrical models of the ventricles, atria, large vessels, liver, and spine were created using computed tomography data. Ten cases of focal ventricular activation were simulated using the bidomain model and the TNNP 2006 cellular model. The population-based values of electrical conductivities and other model parameters were used for accuracy analysis, and their variations were used for sensitivity analysis. The mean correlation coefficient between the simulated and real ECGs varied significantly (from r = 0.29 to r = 0.86) among the simulated cases. A strong mean correlation (r > 0.7) was found in eight of the ten model cases. The accuracy of the ECG simulation varied widely in the same patient depending on the localization of the excitation origin. The sensitivity analysis revealed that variations in the anisotropy ratio, blood conductivity, and cellular apicobasal heterogeneity had the strongest influence on transmembrane potential, while variation in lung conductivity had the greatest influence on body-surface ECGs. Futhermore, the anisotropy ratio predominantly affected the latest activation time and repolarization time dispersion, while the cellular apicobasal heterogeneity mainly affected the dispersion of action potential duration, and variation in lung conductivity mainly led to changes in the amplitudes of ECGs and cardiac electrograms. We also found that the effects of certain parameter variations had specific regional patterns on the cardiac and body surfaces. These observations are useful for further developing personalized cardiac models.
Highlights
The mathematical and numerical modeling of cardiac electrical activity in humans is of considerable significance in basic and clinical cardiac electrophysiology
We compared patient electrocardiograms (PECGs) and simulated ECGs (SECGs) with reference parameters, and we compared the reference SECGs with SECGs computed with different model parameters
We present results of the comparison of SECGs in each of the ten reference models and PECGs, which were recorded with body-surface mapping (BSM) and standard 12-leads
Summary
The mathematical and numerical modeling of cardiac electrical activity in humans is of considerable significance in basic and clinical cardiac electrophysiology. State-of-the-art mathematical models, including the bidomain model of myocardial tissue, coupled with biophysically detailed cellular ionic models, can provide a physiologically-adequate simulation of electrical activity in the myocardium [1]. Cardiac imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI), enable models to include the personal anatomy of the heart, torso, and internal organs. These methods bring researchers closer to solving the challenging problem of creating personal models of the human heart electrical activity. Creating patient-specific cardiac models as a routine clinical procedure is still far from a complete solution
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