Journal
ANNALS OF BIOMEDICAL ENGINEERING
Volume 49, Issue 12, Pages 3143-3153Publisher
SPRINGER
DOI: 10.1007/s10439-021-02825-9
Keywords
His-Purkinje system; Forward ECG modeling; Parameter identification; Computational cardiac modeling; Electrocardiogram
Categories
Funding
- Austrian Science Fund (FWF) [I2760B30]
- BioTechMed-Graz, Austria as a part of the BioTechMedGraz Flagship Project ILearnHeart
- EU H2020 Grant MedalCare [18HLT07]
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Personalized models known as cardiac digital twins (CDTs) have shown promise in tailoring cardiac precision therapies, with a recent study developing an automated two-stage approach for personalization of the His-Purkinje system (HPS). By comparing activation patterns and ECGs, both HPS models were found to preserve predominant ECG morphology under sinus conditions but revealed differences during pacing.
Personalized models of cardiac electrophysiology (EP) that match clinical observation with high fidelity, referred to as cardiac digital twins (CDTs), show promise as a tool for tailoring cardiac precision therapies. Building CDTs of cardiac EP relies on the ability of models to replicate the ventricular activation sequence under a broad range of conditions. Of pivotal importance is the His-Purkinje system (HPS) within the ventricles. Workflows for the generation and incorporation of HPS models are needed for use in cardiac digital twinning pipelines that aim to minimize the misfit between model predictions and clinical data such as the 12 lead electrocardiogram (ECG). We thus develop an automated two stage approach for HPS personalization. A fascicular-based model is first introduced that modulates the endocardial Purkinje network. Only emergent features of sites of earliest activation within the ventricular myocardium and a fast-conducting sub-endocardial layer are accounted for. It is then replaced by a topologically realistic Purkinje-based representation of the HPS. Feasibility of the approach is demonstrated. Equivalence between both HPS model representations is investigated by comparing activation patterns and 12 lead ECGs under both sinus rhythm and right-ventricular apical pacing. Predominant ECG morphology is preserved by both HPS models under sinus conditions, but elucidates differences during pacing.
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