Autores UPV
Pashaei Ali,
Sebastián Aguilar Rafael,
López Pérez Alejandro Daniel,
Soto-Iglesias David,
Ferrero de Loma-Osorio José María,
Andreu David,
Acosta Juan,
Fernández-Armenta Juan,
Berruezo Antonio,
Cámara Óscar
Abstract
Purpose: Idiopathic arrhythmias require long procedures to acquire invasive
electro-anatomical maps and ascertain the right ventricular (RV) or left ventricular
(LV) origin of the ectopic beat. A recent study suggests a correlation between
the shape of the activation-map isochrones in the RV outflow tract (RVOT) and
the origin of the ectopic beat. We propose to study and validate this relationship
with a computational model.
Material and methods: A detailed anatomical model of the LV and RV including
the outflow tracts was built from a magnetic resonance image of a patient.
A finite element mesh was then generated where myofibre architecture was synthetically
introduced. Electrophysiological simulations were performed for 150ms
after the ectopic beat. Four different origins of ectopic beats were analysed: the
left (LV-LAC), non-coronary (LV-NCAC) and right (LV-RAC) aortic cusps; and the
middle of the RVOT. A post-processing step was implemented to derive 20msisochrones
around the earliest activated area in the RVOT and their shape was
characterized (area, axis ratio computed as the maximum over minimum diameters
of the isochrones).
Results: The axis ratio and area indices characterizing the 20ms-isochrones for the four different configurations were: 2.43 and 2.25 cm2 for LV-LAC; 1.74 and
2.55 cm2 for LV-NCAC; 1.16 and 2.95 cm2 for LV-RAC; 2.59 and 1.18 cm2 for
RVOT origin. The earliest activated area in the RVOT appeared 100 ms, 150 ms,
70 ms and 3 ms after the ectopic beat for LV-LAC, LV-NCAC, LV-RAC and RVOT,
respectively.
Conclusions: The developed computational model reproduces the electrical activation
patterns observed in clinical data, clearly identifying larger isochronal areas
and smaller axis ratios with LVOT rather than RVOT origin of the ectopic beat.
