Computational Biomechanics of Ventricular Dyssynchrony and Resynchronization Therapy

Abstract

Cardiac resynchronization therapy (CRT) is one of the few effective treatments for dyssynchronous heart failure (HF), where heart function is worsened due to an electrical substrate pathology causing delayed left ventricular activation. However, 40–50% of patients do not respond to treatment. In this book chapter, we review cardiac computer models of the electrophysiology, electromechanics, and hemodynamics of the heart that have been used to investigate HF pathophysiology and mechanisms underpinning CRT response. In the last decades, multi-scale heart models for dyssynchronous HF have been used to study the optimization of CRT delivery, in particular lead location and device settings, and to investigate emerging technologies to solve dyssynchrony. Nevertheless, these models require a large amount of clinical and experimental data to be generated and parametrized, as well as significant computational resources. These factors limit computational studies to one single heart or small patient numbers. Once these technical challenges are overcome, personalized models of the heart have the potential to help in HF diagnosis and treatment and to be incorporated into the clinical workflow.