A non-invasive and personalized, 3-D virtual heart assessment tool may help physicians prevent arrhythmia, or sudden cardiac death, as well as prevent unnecessary defibrillator implants, according to researchers from Johns Hopkins University.
In a newly published study, the researchers reported that their new digital approach yielded more accurate predictions of future arrhythmic events than current blood pumping measurements. The study appeared in the online journal Nature Communications.
Defibrillators that sense the onset of arrhythmias and jolt the heart back to a normal rhythm in order to prevent sudden death, are invasive, costly and may put patients at risk for infection, device malfunction and, in rare instances, heart or blood vessel damage, according to Natalia Trayanova, senior author of the journal article.
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Trayanova, head of the Computational Cardiology Lab at Hopkins, said that the computer modeling tool is intended to help adults who have previous injury (scarring) in the heart. She added that that the clinical guideline for implantation of a defibillator to prevent sudden cardiac death is an ejection fraction of less than 35 percent.
“You have adults with less and those above 35 percent, regardless of whether or not they have had previous injury. If they have previous injury, they have to have an ejection fraction of less than 35 percent to get a defibrillator. This criteria is very, very inaccurate,” Trayanova said. “As a result, many patients have defibrillators implanted and they don’t need them. There is clearly an unmet clinical need that there are no adequate criteria to address which patients will be at risk for sudden cardiac attack.”
Trayanova explained how the virtual heart determines which patients are at risk for arrthymia and which are not:
We take the patient’s MRI scan and we build the geometry of the heart from the MRI scan. We used a contrast-enhancement MRI scan so that we can see where the bright regions are, and that’s where the scarring is. We reconstruct the geometry of the heart from the MRI scan and these enhanced regions, the scarring. We populate the model with cells. In each element, we put cellular properties. Those are basically equations that describe the dynamics of crossing interactions, ionic channels opening and transport across the membranes. We assign fiber orientation and cellular properties to create the model.
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The researchers also introduced a little electric current at many points in the virtual heart. “Sometimes cells give a little signal. In normal people, nothing happens. But, if it happens in someone with scarring, an arrythmia occurs,” said Trayanova. “If you give these little stimuli throughout the virtual heart, and an electrical wave begins to propagate outside of that stimulus, and this electrical wave gets attached to the scarring and begins to rotate around it, we know this patient will have an arrhythmia at some point in their life.”
Trayanova believes the methodology could have additional uses. “My vision is to have a virtual heart of every patient. The patient comes in, gets scanned, and you create a virtual heart for a diagnostic tool and for treatment modalities,” she said.
Graphic: Hermenegild Arevalo and Natalia Trayanova/Johns Hopkins University
