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Gillette K, Gsell MAF, Bouyssier J, Prassl AJ, Neic A, Vigmond EJ, Plank G. Automated Framework for the Inclusion of a His-Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology. Ann Biomed Eng 2021; 49:3143-3153. [PMID: 34431016 PMCID: PMC8671274 DOI: 10.1007/s10439-021-02825-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 06/26/2021] [Indexed: 11/28/2022]
Abstract
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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Affiliation(s)
- Karli Gillette
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | - Matthias A F Gsell
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
| | - Julien Bouyssier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Anton J Prassl
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria
| | | | - Edward J Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France
| | - Gernot Plank
- Gottfried Schatz Research Center Biophysics, Medical University of Graz, Graz, Austria.
- BioTechMed-Graz, Graz, Austria.
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Vigmond EJ, Bouyssier J, Bayer J, Haïssaguerre M, Ashikaga H. On the nature of delays allowing anatomical re-entry involving the Purkinje network: a simulation study. Europace 2021; 23:i71-i79. [PMID: 33463686 DOI: 10.1093/europace/euaa395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS Clinical observations suggest that the Purkinje network can be part of anatomical re-entry circuits in monomorphic or polymorphic ventricular arrhythmias. However, significant conduction delay is needed to support anatomical re-entry given the high conduction velocity within the Purkinje network. METHODS AND RESULTS We investigated, in computer models, whether damage rendering the Purkinje network as either an active lesion with slow conduction or a passive lesion with no excitable ionic channel, could explain clinical observations. Active lesions had compromised sodium current and a severe reduction in gap junction coupling, while passive lesions remained coupled by gap junctions, but modelled the membrane as a fixed resistance. Both types of tissue could provide significant delays of over 100 ms. Electrograms consistent with those obtained clinically were reproduced. However, passive tissue could not support re-entry as electrotonic coupling across the delay effectively increased the proximal refractory period to an extremely long interval. Active tissue, conversely, could robustly maintain re-entry. CONCLUSION Formation of anatomical re-entry using the Purkinje network is possible through highly reduced gap junctional coupling leading to slowed conduction.
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Affiliation(s)
- Edward J Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Julien Bouyssier
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Jason Bayer
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, IMB, UMR 5251, F-33400 Talence, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Univ. Bordeaux, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, F-33000 Bordeaux, France.,Bordeaux University Hospital (CHU), Electrophysiology and Ablation Unit, F-33600 Pessac, France
| | - Hiroshi Ashikaga
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac-Bordeaux, France.,Cardiac Arrhythmia Service, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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