Simulation of premature ventricular contractions in patient specific bidomain ventricular model

Anotace: The goal of the study was to simulate electrical activation of the heart ventricles and corresponding body surface potentials (BSPs) during premature ventricular contractions (PVC) using the patient specific realistic homogeneous model of cardiac ventricles and the torso. Real position of the initial ectopic activation during PVC was determined by intracardial measurement in the upper part of the right ventricle near the His bundle and confirmed by successful catheter ablation of the PVC origin. Simulated electrical activation in the ventricular model was started at the position of the initial ectopic activation as well as at several other sites at various distances from this position. The propagation of electrical activation in the ventricular model was modeled using bidomain reaction-diffusion (RD) equations with the ionic transmembrane current density defined by the modified FitzHugh-Nagumo (FHN) equations. The torso was modeled as a homogeneous passive volume conductor. The RD equations were numerically solved in the Comsol Multiphysics environment. Simulated ECG signals and BSPs were compared with those measured during PVC in a real patient. The polarity and shape of simulated and measured ECG leads as well as the BSP distribution during the PVC were in best agreement when the stimulated region was less than 10 mm from the position of the initial ectopic activation.