PM.20.050 – A computer simulation approach to enhance the pacemaker lead implantation in a patient specific fashion

Route: Personalised medicine: the individual at the centre

Cluster question: 088 How can we predict, prevent, and treat cardiovascular diseases (atherosclerosis, heart failure, heart arrhythmia, and thrombosis) in individuals at an early stage?

A computer simulation approach to enhance the pacemaker lead implantation in a patient specific fashion
Cardiovascular disease are the number 1 cause of death globally. Heart failure (HF) is a stage of CVD during which a corrective intervention can still be effective to increase cardiac function. By the implantation of an implantable cardiac defibrillator (ICD) and/or a biventricular (BIV) pacemaker sudden cardiac death can be prevented and cardiac function can be optimized. A BIV pacemaker contains two electrodes that are implanted in the left- and right- ventricles in order to achieve optimal stimulation sequence and thereby optimal contraction. Nevertheless the effect of BIV pacemakers on cardiac function is limited. Although BIV is in the guidelines for HF, in 30-40% of patients the desired remodeling of the heart to normal volumes is not achieved. Despite multiple studies that have shown that the implantation locations of the pacemaker electrodes in the failing heart are crucial to maximize the effect of the therapy there is no easy to use technique available yet to implant these electrodes in a standardized way. During the implantation plain X-Ray is used to implant the electrode, which leaves the operator blind for all important soft tissue characteristics (myocardial infarction, electomechanical dyssynchrony) since X-Ray simply only does angiography. In this project we aim to bring all information from diagnostic imaging modalities that are available in hospitals nowadays (MRI, CT, ECGi) into a patient specific finite element model to visualize the patient characteristics in a 3D fashion prior to the implantation procedure, and simulate the effect of electrical stimulation at multiple sites in order to restore the most optimal electrical conduction and mechanical contraction for individual patients. The most appropriate lead locations are displayed in conjunction with X-Ray during the implantation procedure to achieve optimal therapy for HF patients.

Keywords

computer models, heart failure., medical imaging, patient specific therapy

Other organisations

www.cart-tech.com

Submitter

Organisation UMC Utrecht (UMCU)
Name Dr. M. (Mathias) Meine
E-mail nwa-orc2020@nwo.nl