Computational cardiac electrophysiology is moving towards translation medicine

S. Severi, B. Rodriguez, A. Zaza
2014 Europace  
In the present Issue of EP-Europace, we publish the second part of the Focused Issue on 'Computational Cardiac Electrophysiology', which was previously introduced in March 2014. 1 Whereas the first part featured contributions on the computational analysis of 'arrhythmias mechanisms', the present Issue mainly focuses on the descriptions of novel computational approaches for diagnosis and interventions in clinical arrhythmology. In this sense, although there are clearly many challenges that must
more » ... allenges that must still be overcome along the way, the articles in this issue show that Computational Cardiac Electrophysiology is moving towards Translational Medicine. With regard to the application of the computational approach to the antiarrhythmic therapies, Trayanova and Rantner 2 review the insights provided by the three-dimensional (3D) computational models of defibrillation and of shock-induced arrhythmogenesis, including the description of a relevant attempt of clinical translation regarding the model-based prediction of the optimal ICD placement in paediatric and congenital heart defect patients. An original contribution also related to the understanding of arrhythmia induction and defibrillation is the study by Colli Franzone et al. 3 on the spatial distribution of intracellular calcium (Ca i ) dynamics following premature stimulations. In agreement with recent experimental investigations, they found significant regions of Ca i elevation located at the virtual cathode regions. Such spatial heterogeneity in Ca i dynamics may feedback on membrane potential and play an important role in arrhythmia induction by programmed stimulation. Ravelli and Masè 4 review the state of the art of computational mapping in atrial fibrillation (AF). The experimental studies, the signal processing methods and the clinical studies focused on the analysis of rate and organization of AF are reviewed. They point out how the integration of signal-derived maps may guide the localization of critical sources and the planning of new target ablation strategies. In their work, Wiśniowska et al. 5 review successes, issues, and challenges associated with the use of computer-based approaches for cardiac drug safety assessment, including pro-arrhythmia. The review covers a description of in vitro, in vivo, and in silico methods for cardiac drug assessment, and discusses the challenges and limitations associated with their combined use and their validation. The discussion is set to trigger further thoughts and discussions on how computational approaches could be used and what is their expected value in this area. With regard to diagnostic tools, two papers are focused on the use of noninvasive electroanatomical imaging to assess conduction disorders. Seger et al. 6 apply this approach to assess epi-and endocardial ventricular activation during cardiac resynchronization therapy. Their tool may be useful to locate the area of latest ventricular activation, thus helping in the optimization of lead placement. Van Dam et al. 7 propose a noninvasive imaging tool for the early recognition of bundle branch blocks during transcatheter aortic valve implantation. This is essentially a feasibility study, showing how the location of conduction disorders can be precisely defined by advanced computerassisted imaging. Pervolaraki et al. 8 developed a computational model of propagation during normal sinus rhythm in the foetal human heart. Although awaiting validation, the study constitutes a first attempt to model this novel problem and provides a basis for computational interpretation of the response of the foetal electrocardiogram (ECG) under disease states and pharmacological interventions. The ability of septal pacing to capture AF has been investigated by Rusu et al. 9 They found that an AF substrate had a significant impact on the outcome of rapid pacing, thus increasing the information that can be extracted from capture protocols. Dependency on the AF substrate would also explain the high interindividual variability in the response to pacing. In a more theoretical study, Zaniboni and Cacciani 10 adopt a novel 3D representation of cardiac action potential to compactly visualize and analyse the dynamical properties of human cellular ventricular repolarization. This representation identifies an auto-regenerativerepolarization-phase, suitable to estimate repolarization stability, and its response to drugs, in single and coupled myocytes. The concept is relevant to the in silico prediction of proarrhythmia. Together, the two parts of this Focused Issue on Computational Cardiac Electrophysiology offer a comprehensive overview of the state of the art of computational approaches for studies of the mechanisms, diagnosis, and treatment of arrhythmogenesis. Moreover, two additional papers will be published in a following issue of EP-Europace. The first one is a computational study on the effects of b-blockers on AF, in which Kharche et al. 11 show that AF
doi:10.1093/europace/euu085 pmid:24798959 fatcat:zjfmo6rqvbeezk5oq7fcbupi5u