title: Patient-specific modelling of cardiac electrophysiology in heart-failure patients.
abstract: OBJECTIVE
  Left-ventricular (LV) conduction disturbances are common in heart-failure patients and a left bundle-branch block (LBBB) electrocardiogram (ECG) type is often seen. The precise cause of this pattern is uncertain and is probably variable between patients, ranging from proximal interruption of the left bundle branch to diffuse distal conduction disease in the working myocardium. Using realistic numerical simulation methods and patient-tailored model anatomies, we investigated different hypotheses to explain the observed activation order on the LV endocardium, electrogram morphologies, and ECG features in two patients with heart failure and LBBB ECG.
  
  
  RESULTS
  Ventricular electrical activity was simulated using reaction-diffusion models with patient-specific anatomies. From the simulated action potentials, ECGs and cardiac electrograms were computed by solving the bidomain equation. Model parameters such as earliest activation sites, tissue conductivity, and densities of ionic currents were tuned to reproduce the measured signals. Electrocardiogram morphology and activation order could be matched simultaneously. Local electrograms matched well at some sites, but overall the measured waveforms had deeper S-waves than the simulated waveforms.
  
  
  CONCLUSIONS
  Tuning a reaction-diffusion model of the human heart to reproduce measured ECGs and electrograms is feasible and may provide insights in individual disease characteristics that cannot be obtained by other means.
authors.affiliation: Center for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland Inria Bordeaux Sud-Ouest, 33405 Talence CEDEX, France mark@potse.nl.
authors.forename: Mark
authors.initials: M
authors.lastname: Potse
authors.affiliation: Institute of Computational Science, Faculty of Informatics, Università della Svizzera italiana, 6904 Lugano, Switzerland.
authors.forename: Dorian
authors.initials: D
authors.lastname: Krause
authors.affiliation: Institute of Computational Science, Faculty of Informatics, Università della Svizzera italiana, 6904 Lugano, Switzerland.
authors.forename: Wilco
authors.initials: W
authors.lastname: Kroon
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, 6904 Lugano, Switzerland.
authors.forename: Romina
authors.initials: R
authors.lastname: Murzilli
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, 6904 Lugano, Switzerland.
authors.forename: Stefano
authors.initials: S
authors.lastname: Muzzarelli
authors.affiliation: Division of Cardiology, Fondazione Cardiocentro Ticino, 6904 Lugano, Switzerland.
authors.forename: François
authors.initials: F
authors.lastname: Regoli
authors.affiliation: Department of Electronics, Information, and Bioengineering, Politecnico di Milano, 20133 Milano, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Caiani
authors.affiliation: Center for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6229 ER Maastricht, The Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.affiliation: Center for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland Institute of Computational Science, Faculty of Informatics, Università della Svizzera italiana, 6904 Lugano, Switzerland.
authors.forename: Rolf
authors.initials: R
authors.lastname: Krause
authors.affiliation: Center for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera italiana, Via Giuseppe Buffi 13, 6904 Lugano, Switzerland Division of Cardiology, Fondazione Cardiocentro Ticino, 6904 Lugano, Switzerland.
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000200:Action Potentials; D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000503:physiopathology*; D003198:Computer Simulation; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008955:Models, Cardiovascular; D009716:Numerical Analysis, Computer-Assisted; D011237:Predictive Value of Tests; D016277:Ventricular Function, Left
keywords: Computer models; Conduction disorders; Heart failure; Left bundle-branch block