The purkinje system and cardiac geometry: Assessing their influence on the paced heart

Abstract

Whole heart computer models are being widely used to assess treatment planning like Cardiac Resynchronization Therapy (CRT), a recognized treatment for heart failure. Certain aspects like cardiac geometry and the Purkinje system (PS) are still sometimes neglected on the studies. The present study includes a model of the human ventricles with incorporated anatomical structures such as myofibers orientation and Purkinje system. Two meshes representative of hypertrophic and dilated cardiomyopathies were generated from an original healthy subject mesh. In the context of (III) atrio-ventricular (AV) block, a sequential pacing protocol was tested for different device configurations. The pacing protocols were performed in models including the PS and in models lacking the PS. The results show that the Purkinje System leads to the synchronization of the septum and the left ventricle (LV) lateral wall, thus minimizing the interventricular delay. Also the modifications in the geometry resulted in changes in the activation patterns of the LV lateral wall, differing notably from physiological scenario. © 2009 Springer Berlin Heidelberg.