Individualized Cardiac Resynchronization Therapy: Next Generation Pacemaker Controls
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Abstract
Cardiac dyssynchrony (CD) causes some heart muscle regions to contract at different times, and current treatments do not help 30 – 50% of patients. In this thesis, multi-site pacing control schemes are created to quantitatively and automatically reduce the CD of ventricular wall accelerations by adjusting pacing times. Two and four left ventricular region models are investigated containing model variables that represent numerous muscle parameters. Optimization is performed using exhaustive search and genetic algorithm techniques, with particular attention paid to the latter with regard to development, parameter selection, and limitations. Relative to treatments firing all regions simultaneously, timing adjustment improves acceleration CD by up to 56%. Furthermore, simulations also demonstrate improvements to dyssynchronous region power generation and workload by up to 50% and up to 15% decrease in healthy region workload. Thus, the current model indicates it may be possible to improve acceleration CD by adjustments to regional firing times.