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The high frequency (HF) catheter ablation is the gold standard for the therapy of many cardiac tachyarrhythmias, such as atrioventricular node re-entry tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT) or atrial flutter (AFL). The aim of the study was to simulate the HF ablation of AVNRT, AVRT, AFL and its heat propagation in reference to the supplied power with different electrode material and electrode size. The modeling and simulation were performed with the thermal and electromagnetic simulation software CST® (Computer Simulation Technology, Darmstadt). The modeling and simulation were carried out using ablation catheters with 4 mm tip electrode and 8 mm tip electrode with different electrode materials. Both electrode types were made of platinum and gold respectively. For the measurement of the heat propagation in the heart tissue, the catheters were integrated in the Offenburg heart rhythm model. The HF ablation procedures were performed with the 4 mm platinum tip electrode, with an application duration of 45 seconds and a power output of 40 watts. The HF ablation of the atrioventricular node slow pathway produced a maximum temperature of 66.33 °C. The Kent bundle HF ablation in the left atrium achieved a maximum temperature of 67.14 °C. The HF ablation of the right atrial isthmus resulted 65.96 °C. The 8 mm distal platinum tip electrode and a power output of 60 watts reached 72.85 °C. The 8 mm distal gold tip electrode and a power output of 60 watt reached 64.66 °C, due to the improved thermal conductivity of gold. Virtual heart and ablation electrode models allow the static and dynamic simulation of HF ablation with different electrode material and electrode size. The 3D simulation of the temperature profile may be used to optimize the AVNRT, AVRT and AFL HF ablation.
Die Katheterablation mit Hochfrequenzstrom (HF) ist der Goldstandard für die Therapie vieler kardi-aler Tachyarrhythmien. Bei der HF-Ablation entstehen Temperaturen zwischen 50 °C und 70 °C, wo-durch bestimmte Strukturen im Herzgewebe gezielt zerstört werden können. Ziel der Studie ist, die HF-Ablation und deren Wärmeausbreitung in Bezug auf die zugeführte Leistung mit unterschiedli-chem Elektrodenmaterial und Elektrodengröße bei supraventrikülären Tachykardien zu simulieren.
Background: The application of high-frequency ablation is used for the treatment of tachycardia arrhythmias and is a respected method. Ablation with high frequency current leads to the targeted heat destruction of myocardial tissue at specific sites and thus prevents the pathological propagation of excitation through these structures.
Purpose: The aim of this study was to simulate heat propagation during RF ablation with modeled electrodes in different sizes and materials. The simulation was performed on atrioventricular node re-entry tachycardia (AVNRT), atrioventricular re-entry tachycardia (AVRT) and atrial flutter (AFL).
Methods: Using the modeling and simulation software CST, ablation catheters with 4 mm and 8 mm tip electrodes were modeled from gold and platinum for each. The designed catheters correspond to the manufacturer"s specifications of Medtronic, Biotronik and Osypka. The catheters were integrated into the Offenburg heart rhythm model to simulate and compare the heat propagation during an ablation application, which also takes into account the blood flow in the four heart chambers. A power of 5 W - 40 W was simulated for the 4 mm electrodes and a power of 50 W - 80 W for the 8 mm electrodes.
Results: During the simulated HF ablation application, the temperature at the ablation electrode was measured at different powers. This is 40.67°C at 5 W, 44.34°C at 10 W, 51.76°C at 20 W, 59.0°C at 30 W, and 66.33°C at 40 W. The measured temperature during 40 W application is 39.5°C at 0,5 mm depth in the myocardium and 37.5°C at 2 mm depth.
In the simulation, the 8 mm platinum electrode reached an ablation temperature of 72.85°C at its tip during an applied power of 60 W. In contrast, the 8 mm platinum electrode reached a depth of 5 mm at 39.5 C° and at a depth of 2 mm at 37.5 °C. In contrast, the 8 mm gold electrode reached a temperature of 64.66°C with the same performance. This is due to the thermal properties of gold, which has a better thermal conductivity than platinum.
Conclusions: CST offers the possibility to carry out a static and dynamic simulation of a heart model and the ablation electrodes integrated in it during an HF ablation. In variation with different electrode sizes and materials, therapy methods for the treatment of AVNRT, AVRT and AFL can be optimized
Abstract: Electric field of biventricular (BV) pacing, left ventricular (LV) electrode position and electrical interventricular desynchronization are important parameters for successful cardiac resynchronization therapy (CRT) in patients with heart failure, sinus rhythm and reduced LV ejection fraction. The aim of the study was to evaluate electric pacing field of transesophageal left atrial (LA) pacing and BV pacing with 3D heart rhythm simulation. Bipolar right atrial (RA), right ventricular (RV), LV electrodes and multipolar hemispherical esophageal LA electrodes were modeled with CST (Computer Simulation Technology, Darmstadt). Electric pacing field were simulated with bipolar RA and RV pacing with Solid S (Biotronik) electrode, bipolar LV pacing with Attain 4194 (Medtronic) electrode and bipolar LA pacing with TO8 (Osypka) esophageal electrode. 3D heart rhythm model with esophagus allowed electric pacing field simulation of 4-chamber pacing with bipolar intracardiac RA, RV, LV pacing and bipolar transesophageal LA pacing. The pacing amplitudes were 3V RA pacing amplitude, 50V LA pacing amplitude, 1.5V RV pacing amplitude and 3V LV pacing amplitude with 0.5ms pacing pulse duration. The atrioventricular delay between RA pacing and BV pacing was 140ms atrioventricular pacing delay and simultaneous RV and LV pacing. Electric pacing fields were simulated during the different pacing modes AAI, VVI, DDD and DDD0V. The intracardiac far-field pacing potentials were evaluated with intracardiac electrodes and a distance of 1mm from the electrodes with RA electrode 1.104V, RV electrode 0.703V and LV electrode 1.32V. The transesophageal far-field pacing potential was evaluated with transesophageal electrode and a distance of 10mm from the elelctrode with LA electrode 6.076V. Heart rhythm model simulation with esophagus allows evaluation of electric pacing fields in AAI, VVI, DDD, DDD0V and DDD0D pacing modes. Electric pacing field of RA, RV and LV pacing in combination with LA pacing may additional useful pacing mode in CRT non-responders.
Background: Transesophageal left atrial (LA) pacing and transesophageal LA ECG recording are semi-invasive techniques for diagnostic and therapy of supraventricular rhythm disturbance. Cardiac resynchronization therapy (CRT) with right atrial (RA) sensed biventricular pacing is an established therapy for heart failure patients with reduced left ventricular (LV) ejection fraction, sinus rhythm and interventricular electrical desynchronization.
Purpose: The aim of the study was to evaluate electromagnetic and voltage pacing fields of the combination of RA pacing, LA pacing and biventricular pacing in patients with long interatrial and interventricular electrical desynchronization.
Methods: The modelling and electromagnetic simulations of transesophageal LA pacing in combination with RA pacing and biventricular pacing would be staged and analyzed with the CST (Computer Simulation Technology) software. Different electrodes were modelled in order to simulate different types of bipolar pacing in the 3D-CAD Offenburg heart rhythm model: The bipolar Solid S (Biotronik) electrode where modelled for RA pacing and right ventricular (RV) pacing, Attain 4194 (Medtronic) for LV pacing and TO8 (Osypka) multipolar esophageal electrode with hemispheric electrodes for LA pacing.
Results: The pacemaker amplitudes for the electromagnetic pacing simulations were performed with 3 V for RA pacing, 1.5 V for RV pacing, 50 V for LA pacing and 3V for LV pacing with pacing impulse duration of 0.5 ms for RA, RV and LV pacing and 10 ms for LA pacing. The atrioventricular pacing delay after RA pacing was 140 ms. The different pacing modes AAI, VVI, DDD, DDD0V and DDD0D were evaluated for the analysis of the electric pacing field propagation of pacemaker, CRT and LA pacing. The pacing results were compared at minimum (LOW) and maximum (HIGH) parameter settings. While the LOW setting produced fewer tetrahedral and more inaccurate results, the HIGH setting produced many tetrahedral and therefore more accurate results.
Conclusions: The simulation of the combination of transesophageal LA pacing with RA sensed biventricular pacing is possible with the Offenburg heart rhythm model. The new temporary 4-chamber pacing method may be additional useful method in CRT non-responders with long interatrial electrical delay.
Background: The electrical field (E-field) of the biventricular (BV) stimulation is important for the success of cardiac resynchronization therapy (CRT) in patients with cardiac insufficiency and widened QRS complex. The 3D modeling allows the simulation of CRT and high frequency (HF) ablation.
Purpose: The aim of the study was to model different pacing and ablation electrodes and to integrate them into a heart model for the static and dynamic simulation of atrial and BV stimulation and high frequency (HF) ablation in atrial fibrillation (AF).
Methods: The modeling and simulation was carried out using the electromagnetic simulation software CST (CST Darmstadt). Five multipolar left ventricular (LV) electrodes, one epicardial LV electrode, four bipolar right atrial (RA) electrodes, two right ventricular (RV) electrodes and one HF ablation catheter were modeled. Selected electrodes were integrated into the Offenburg heart rhythm model for the electrical field simulation. The simulation of an AV node ablation at CRT was performed with RA, RV and LV electrodes and integrated ablation catheter with an 8 mm gold tip.
Results: The right atrial stimulation was performed with an amplitude of 1.5 V with a pulse width of 0.5. The far-field potentials generated by the atrial stimulation were perceived by the right and left ventricular electrode. The far-field potential at a distance of 1 mm from the right ventricular electrode tip was 36.1 mV. The far-field potential at a distance of 1 mm from the left ventricular electrode tip was measured with 37.1 mV. The RV and LV stimulation were performed simultaneously at amplitude of 3 V at the LV electrode and 1 V at the RV electrode with a pulse width of 0.5 ms each. The far-field potentials generated by the BV stimulations could be perceived by the RA electrode. The far-field potential at the RA electrode tip was 32.86 mV. AV node ablation was simulated with an applied power of 5 W at 420 kHz and 10 W at 500 kHz at the distal 8 mm ablation electrode.
Conclusions: Virtual heart and electrode models as well as the simulations of electrical fields and temperature profiles allow the static and dynamic simulation of atrial synchronous BV stimulation and HF ablation at AF. The 3D simulation of the electrical field and temperature profile may be used to optimize the CRT and AF ablation.
Die vorliegende Erfindung betrifft Steuer- und Regeleinheiten für eine extrakorporale Kreislaufunterstützung sowie Systeme, umfassend eine solche Steuer- und Regeleinheit und entsprechende Verfahren. Entsprechend wird eine Steuer- und Regeleinheit Steuer- und Regeleinheit (10) für eine extrakorporale Kreislaufunterstützung vorgeschlagen, welche dazu eingerichtet ist eine Messung eines EKG-Signals (12) eines unterstützten Patienten über einen vorgegebenen Zeitraum zu empfangen, wobei das EKG-Signal (12) für jeden Zeitpunkt innerhalb eines Herzzyklus mehrere Datenpunkte umfasst. Die Steuer- und Regeleinheit (10) umfasst eine Auswerteeinheit (100), welche dazu eingerichtet ist, die Datenpunkte für mindestens einen Zeitpunkt räumlich und/oder zeitlich auszuwerten und aus den ausgewerteten Datenpunkten mindestens eine Amplitudenänderung (14) innerhalb des Herzzyklus zu bestimmen. Die Steuer- und Regeleinheit (10) ist weiterhin dazu eingerichtet, ein Steuer- und/oder Regelsignal (16) für die extrakorporale Kreislaufunterstützung an einem vorgegebenen Zeitpunkt nach der mindestens einen Amplitudenänderung (14) auszugeben.
The present invention relates to open-loop and closed-loop control units for extracorporeal circulatory support, to systems comprising such an open-loop and closed-loop control unit, and to corresponding methods. An open-loop and closed-loop control unit (10) for extracorporeal circulatory support is proposed, which is configured to receive a measurement of an ECG signal (12) of a supported patient over a predefined period of time, wherein the ECG signal (12) comprises multiple data points for each time point within a heart cycle. The open-loop and closed-loop control unit (10) comprises an evaluation unit (100) which is configured to evaluate the data points for at least one time point in a spatial and/or temporal manner and to determine at least one amplitude change (14) within the heart cycle based on the evaluated data points. The open-loop and closed-loop control unit (10) is further configured to output an open-loop and/or closed-loop signal (16) for extracorporeal circulatory support at a predefined point in time after the at least one amplitude change (14).