title: Noninvasive, automatic optimization strategy in cardiac resynchronization therapy.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Computational Biology Center, IBM TJ Watson Research Center, Yorktown Heights, New York 10598, USA. mreumann@ieee.org
authors.forename: Matthias
authors.initials: M
authors.lastname: Reumann
authors.forename: Brigitte
authors.initials: B
authors.lastname: Osswald
authors.forename: Olaf
authors.initials: O
authors.lastname: Doessel
mesh_terms: D002037:Bundle-Branch Block / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D003198:Computer Simulation; D017147:Defibrillators, Implantable; D006801:Humans