Abstract
Purpose: Heart failure patients are often affected by a ventricular conduction disorder. Accurate characterization of the tridimensional (3D) activation sequence of the ventricles is fundamental for an effective personalized therapy. Electroanatomical mapping provides the activation times at the endocardium, with limited coverage due to anatomical constraints. Our aim is to develop a robust tool to generate a complete 3D, biventricular activation map from a limited number of endocardial measurements.
Method: In 6 candidates to cardiac resynchronization therapy a high density endocardial activation map of the right and left ventricle was obtained. High resolution propagating activation was simulated in patient-tailored anatomical heart models using the anisotropic eikonal equation and realistic fiber orientation. The mean square error between the measured and simulated activation times was minimized by repeated simulations, varying early activation site(s) and local anisotropic conduction velocities. The mathematical formulation is flexible in terms of the number of activation sites and a possible delay between them, in order to mimic the presence of a partially working Purkinje network.
Results: A close correlation was achieved between the simulated and measured activation time for a single patient (Panel A) while detailed 3D activation maps were achieved (Panel B and C). Each individual estimation of the activation map took less than 2 seconds, and the optimal parameters were identified within a few minutes. A 0.9 to 0.95 correlation between measured and simulated activation times was obtained in all cases.
Conflict of interest: none
