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Medical & Biological Engineering & Computing

, Volume 52, Issue 10, pp 813–826 | Cite as

Patient-specific generation of the Purkinje network driven by clinical measurements of a normal propagation

  • Christian VergaraEmail author
  • Simone Palamara
  • Domenico Catanzariti
  • Fabio Nobile
  • Elena Faggiano
  • Cesarino Pangrazzi
  • Maurizio Centonze
  • Massimiliano Maines
  • Alfio Quarteroni
  • Giuseppe Vergara
Original Article

Abstract

The propagation of the electrical signal in the Purkinje network is the starting point for the activation of the ventricular muscular cells leading to the contraction of the ventricle. In the computational models, describing the electrical activity of the ventricle is therefore important to account for the Purkinje fibers. Until now, the inclusion of such fibers has been obtained either by using surrogates such as space-dependent conduction properties or by generating a network based on an a priori anatomical knowledge. The aim of this work was to propose a new method for the generation of the Purkinje network using clinical measures of the activation times on the endocardium related to a normal electrical propagation, allowing to generate a patient-specific network. The measures were acquired by means of the EnSite NavX system. This system allows to measure for each point of the ventricular endocardium the time at which the activation front, that spreads through the ventricle, has reached the subjacent muscle. We compared the accuracy of the proposed method with the one of other strategies proposed so far in the literature for three subjects with a normal electrical propagation. The results showed that with our method we were able to reduce the absolute errors, intended as the difference between the measured and the computed data, by a factor in the range 9–25 %, with respect to the best of the other strategies. This highlighted the reliability of the proposed method and the importance of including a patient-specific Purkinje network in computational models.

Keywords

Purkinje fibers Computational methods Activation times Eikonal equation EnSite NavX system 

Abbreviations

PF

Purkinje fibers

CCS

Cardiac conduction system

PMJ

Purkinje muscular junctions

MRI

Magnetic resonance imaging

3D

Three dimensional

AV

Atrioventricular

ECG

Electrocardiogram

Notes

Acknowledgments

The present study has been funded by Fondazione Cassa di Risparmio di Trento e Rovereto (CARITRO) within the project “Numerical modelling of the electrical activity of the heart for the study of the ventricular dyssynchrony”. The authors would like also to acknowledge St. Jude Medical Inc. and in particular Eng Indiani for their helpful assistance for the description of the technical characteristics of the NavX system.

Conflict of interest

We state that there are no disclosures.

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Copyright information

© International Federation for Medical and Biological Engineering 2014

Authors and Affiliations

  • Christian Vergara
    • 1
    Email author
  • Simone Palamara
    • 2
  • Domenico Catanzariti
    • 3
  • Fabio Nobile
    • 2
    • 4
  • Elena Faggiano
    • 2
    • 5
  • Cesarino Pangrazzi
    • 3
  • Maurizio Centonze
    • 6
  • Massimiliano Maines
    • 3
  • Alfio Quarteroni
    • 2
    • 4
  • Giuseppe Vergara
    • 3
  1. 1.Dipartimento di IngegneriaUniversità di BergamoDalmineItaly
  2. 2.MOX, Dipartimento di MatematicaPolitecnico di MilanoMilanItaly
  3. 3.Divisione di CardiologiaOspedale S. Maria del CarmineRoveretoItaly
  4. 4.MATHICSE-CSQIÉcole Polytechnique Fédérale de LausanneLausanneSwitzerland
  5. 5.LaBS, Dipartimento di Chimica, Materiali e Ingegneria ChimicaPolitecnico di MilanoMilanItaly
  6. 6.U.O. di Radiologia di Borgo-PergineBorgo ValsuganaItaly

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