Computer-based modeling and simulation in the analysis of cardiac arrhythmias and cardiac pacing

Sammanfattning: Most systems for ECG analysis deal with QRS classification and arrhythmia detection but do not address the problem of finding the underlying mechanism responsible for the manifest arrhythmia. Although it is possible to distinguish among different arrhythmogenic mechanisms on the cellular level, it is far more difficult in the clinic based on ECG recordings. A computer model which is well suited for rhythm studies has been developed. The heart is modeled as a network of finite elements in which the impulse propagation is described mathematically, as well as several arrhythmogenic mechanisms. These include modulated parasystole, macro and micro reentry and different kinds of block. Since modulated parasystole provides a unified explanation of a variety of different arrhythmias, a stepwise procedure is presented by which this mechanism can be detected. Modulated parasystole can be described mathematically with a phase response curve, and the model has proven valuable for deduction of biand triphasic phase response curves from clinical cases with frequent ventricular premature complexes.Cardiac pacing is a very important therapy for rhythm disorders and since modern pacemakers interact with the heart in a complex way, the problem of cardiac pacing and pacemaker follow-up has also been studied. An ambulatory recording system has been developed, including a pacemaker spike detector and a computer program which can detect possible events of pacemaker malfunction. The computer model has been used to analyse the interaction between the heart and different types of pacemakers. The model has also been integrated with a hypertext system, allowing the system to be used for computer-aided education of cardiac pacing and cardiac arrhythmias.