Transition mechanisms from atrial flutter to atrial fibrillation during anti-tachycardia pacing therapy.

Background: Atrial anti-tachycardia pacing (aATP) has been shown to be effective for the termination of atrial tachyarrhythmias, but its success rate is still not high enough.

Objective: The main objective of this study was to investigate the mechanisms of atrial flutter (AFL) termination by aATP and the transition from AFL to atrial fibrillation (AF) during aATP.

Methods: We developed a multi-scale model of the human atrium based on magnetic resonance images and examined the atrial electrophysiology of AFL during aATP with a ramp protocol.

Low-energy defibrillation using a base-apex epicardial electrode.

Background: Current implantable cardioverter defibrillators (ICDs) require electric conduction with high voltage and high energy, which can impair cardiac function and induce another malignant arrhythmia. As a result, there has been a demand for an ICD that can effectively operate with lower energy to mitigate the risks of a strong electric shock.

Methods: A pair of sheet-shaped electrodes covering the heart were analyzed in three configurations (top-bottom, left-right, and front-back) using a heart simulator.

A thermodynamically consistent monte carlo cross-bridge model with a trapping mechanism reveals the role of stretch activation in heart pumping.

Changes in intracellular calcium concentrations regulate heart beats. However, the decline in the left ventricular pressure during early diastole is much sharper than that of the Ca transient, resulting in a rapid supply of blood to the left ventricle during the diastole. At the tissue level, cardiac muscles have a distinct characteristic, known as stretch activation, similar to the function of insect flight muscles.

UT-Heart: A Finite Element Model Designed for the Multiscale and Multiphysics Integration of our Knowledge on the Human Heart.

To fully understand the health and pathology of the heart, it is necessary to integrate knowledge accumulated at molecular, cellular, tissue, and organ levels. However, it is difficult to comprehend the complex interactions occurring among the building blocks of biological systems across these scales. Recent advances in computational science supported by innovative high-performance computer hardware make it possible to develop a multiscale multiphysics model simulating the heart, in which the behavior of each cell model is controlled by molecular mechanisms and the cell models themselves are arranged to reproduce elaborate tissue structures.

A Multiple Step Active Stiffness Integration Scheme to Couple a Stochastic Cross-Bridge Model and Continuum Mechanics for Uses in Both Basic Research and Clinical Applications of Heart Simulation.

In a multiscale simulation of a beating heart, the very large difference in the time scales between rapid stochastic conformational changes of contractile proteins and deterministic macroscopic outcomes, such as the ventricular pressure and volume, have hampered the implementation of an efficient coupling algorithm for the two scales. Furthermore, the consideration of dynamic changes of muscle stiffness caused by the cross-bridge activity of motor proteins have not been well established in continuum mechanics. To overcome these issues, we propose a multiple time step scheme called the multiple step active stiffness integration scheme (MusAsi) for the coupling of Monte Carlo (MC) multiple steps and an implicit finite element (FE) time integration step.

Semi-Implicit Time Integration with Hessian Eigenvalue Corrections for a Larger Time Step in Molecular Dynamics Simulations.

In molecular dynamics simulations, the limited time step size has been a barrier to simulating long-time behaviors. Implicit time integration methods allow markedly larger time steps than the standard explicit time method, although they have major drawbacks such as overheads solving linear systems and instability of Newton iterations. To overcome these issues, we propose a semi-implicit time integration scheme, the semi-implicit Hessian correction (SimHec) scheme, for overdamped Langevin dynamics.

A reverse stroke characterizes the force generation of cardiac myofilaments, leading to an understanding of heart function.

Changes in the molecular properties of cardiac myosin strongly affect the interactions of myosin with actin that result in cardiac contraction and relaxation. However, it remains unclear how myosin molecules work together in cardiac myofilaments and which properties of the individual myosin molecules impact force production to drive cardiac contractility. Here, we measured the force production of cardiac myofilaments using optical tweezers.

An application of a patient-specific cardiac simulator for the prediction of outcomes after mitral valve replacement: a pilot study.

Despite advancements in preoperative prediction of patient outcomes, determination of the most appropriate surgical treatments for patients with severely impaired cardiac function remains a challenge. "UT-Heart" is a multi-scale, multi-physics heart simulator, which can be used to assess the effects of treatment without imposing any burden on the patients. This retrospective study aimed to assess whether UT-Heart can function as a tool that aids decision making for performing mitral valve replacements (MVR) in patients with severe mitral regurgitation (MR) and impaired left ventricular (LV) function.

Chloroquine and hydroxychloroquine provoke arrhythmias at concentrations higher than those clinically used to treat COVID-19: A simulation study.

The risk of fatal arrhythmias is the major concern for using chloroquine (CQ) or hydroxychloroquine (HCQ) to treat coronavirus disease 2019 (COVID-19), but the reported number of life-threatening arrhythmic events or deaths is relatively small. The objective of this study was to assess the arrhythmogenic risk of these two drugs using a multiscale heart simulation, which allows testing even at high concentrations, including those that cause fatal arrhythmias. We measured the inhibitory action of CQ, HCQ, and HCQ with 30 μM azithromycin (AZ) on six ion currents (fast [INa] and late [INa,L] components of the sodium current, L-type calcium current [ICa,L], rapid [IKr/hERG], and slow [IKs] components of delayed rectifier potassium, and inward rectifier potassium [IK1]) over a wide range of concentrations using the automated patch-clamp system.

Ionic mechanisms of ST segment elevation in electrocardiogram during acute myocardial infarction.

ST elevation on an electrocardiogram is a hallmark of acute transmural ischemia. However, the underlying mechanism remains unclear. We hypothesized that high ischemic sensitivities of epicardial adenosine triphosphate-sensitive potassium (IK) and sodium (INa) currents play key roles in the genesis of ST elevation.

Using Systolic Local Mechanical Load to Predict Fiber Orientation in Ventricles.

A simple rule adopted for myofiber reorientation in the ventricles is pursued by taking the microscopic branching network of myocytes into account. The macroscopic active tension generated on the microscopic branching structure is modeled by a multidirectional active stress tensor, which is defined as a function of the strains in the branching directions. In our reorientation algorithm, the principal direction of the branching network is updated so that it turns in the direction of greater active tension in the isovolumetric systole.

Patient-specific heart simulation can identify non-responders to cardiac resynchronization therapy.

To identify non-responders to cardiac resynchronization therapy (CRT), various biomarkers have been proposed, but these attempts have not been successful to date. We tested the clinical applicability of computer simulation of CRT for the identification of non-responders. We used the multi-scale heart simulator "UT-Heart," which can reproduce the electrophysiology and mechanics of the heart based on a molecular model of the excitation-contraction mechanism.

Personalized Perioperative Multi-scale, Multi-physics Heart Simulation of Double Outlet Right Ventricle.

For treatment of complex congenital heart disease, computer simulation using a three-dimensional heart model may help to improve outcomes by enabling detailed preoperative evaluations. However, no highly integrated model that accurately reproduces a patient's pathophysiology, which is required for this simulation has been reported. We modelled a case of complex congenital heart disease, double outlet right ventricle with ventricular septal defect and atrial septal defect.

Longitudinal dissociation and transition in thickness of the His-Purkinje system cause various QRS waveforms of surface ECG under His bundle pacing: A simulation study based on clinical observations.

Aims: His bundle pacing (HBP) is a feasible and reliable alternative to conventional right ventricular pacing (RVP), but associated ECG (electrocardiogram) changes have not been well-studied. This study aimed to determine the mechanisms underlying ECG changes associated with HBP using patient-specific multiscale heart simulations.

Methods: ECGs were recorded in two patients who were treated by HBP under a native rhythm and HBP at high and low voltages.

Clinical and pharmacological application of multiscale multiphysics heart simulator, UT-Heart.

A heart simulator, UT-Heart, is a finite element model of the human heart that can reproduce all the fundamental activities of the working heart, including propagation of excitation, contraction, and relaxation and generation of blood pressure and blood flow, based on the molecular aspects of the cardiac electrophysiology and excitation-contraction coupling. In this paper, we present a brief review of the practical use of UT-Heart. As an example, we focus on its application for predicting the effect of cardiac resynchronization therapy (CRT) and evaluating the proarrhythmic risk of drugs.

Effect of myofibril passive elastic properties on the mechanical communication between motor proteins on adjacent sarcomeres.

Rapid sarcomere lengthening waves propagate along a single muscle myofibril during spontaneous oscillatory contraction (SPOC). In asynchronous insect flight muscles, SPOC is thought to be almost completely synchronized over the entire myofibril. This phenomenon does not require Ca regulation of the dynamics of the motor proteins, and cannot be explained simply by the longitudinal mechanical equilibrium among sarcomeres in the myofibril.

Effect of intercostal muscle contraction on rib motion in humans studied by finite element analysis.

The effect of intercostal muscle contraction on generating rib motion has been investigated for a long time and is still controversial in physiology. This may be because of the complicated structure of the rib cage, making direct prediction of the relationship between intercostal muscle force and rib movement impossible. Finite element analysis is a useful tool that is good at solving complex structural mechanic problems.

Arrhythmic hazard map for a 3D whole-ventricle model under multiple ion channel block.

Background And Purpose: To date, proposed in silico models for preclinical cardiac safety testing are limited in their predictability and usability. We previously reported a multi-scale heart simulation that accurately predicts arrhythmogenic risk for benchmark drugs.

Experimental Approach: We created a comprehensive hazard map of drug-induced arrhythmia based on the electrocardiogram (ECG) waveforms simulated under wide range of drug effects using the multi-scale heart simulator described here, implemented with cell models of human cardiac electrophysiology.

Coupling Langevin Dynamics With Continuum Mechanics: Exposing the Role of Sarcomere Stretch Activation Mechanisms to Cardiac Function.

High-performance computing approaches that combine molecular-scale and macroscale continuum mechanics have long been anticipated in various fields. Such approaches may enrich our understanding of the links between microscale molecular mechanisms and macroscopic properties in the continuum. However, there have been few successful examples to date owing to various difficulties associated with overcoming the large spatial (from 1 nm to 10 cm) and temporal (from 1 ns to 1 ms) gaps between the two scales.

Absence of Rapid Propagation through the Purkinje Network as a Potential Cause of Line Block in the Human Heart with Left Bundle Branch Block.

Cardiac resynchronization therapy is an effective device therapy for heart failure patients with conduction block. However, a problem with this invasive technique is the nearly 30% of non-responders. A number of studies have reported a functional line of block of cardiac excitation propagation in responders.

Coordinated force generation of skeletal myosins in myofilaments through motor coupling.

In contrast to processive molecular motors, skeletal myosins form a large motor ensemble for contraction of muscles against high loads. Despite numerous information on the molecular properties of skeletal myosin, its ensemble effects on collective force generation have not been rigorously clarified. Here we show 4 nm stepwise actin displacements generated by synthetic myofilaments beyond a load of 30 pN, implying that steps cannot be driven exclusively by single myosins, but potentially by coordinated force generations among multiple myosins.

Multi-scale, tailor-made heart simulation can predict the effect of cardiac resynchronization therapy.

Background: The currently proposed criteria for identifying patients who would benefit from cardiac resynchronization therapy (CRT) still need to be optimized. A multi-scale heart simulation capable of reproducing the electrophysiology and mechanics of a beating heart may help resolve this problem. The objective of this retrospective study was to test the capability of patient-specific simulation models to reproduce the response to CRT by applying the latest multi-scale heart simulation technology.

Analysis of spontaneous oscillations for a three-state power-stroke model.

Our study considers the mechanism of the spontaneous oscillations of molecular motors that are driven by the power stroke principle by applying linear stability analysis around the stationary solution. By representing the coupling equation of microscopic molecular motor dynamics and mesoscopic sarcomeric dynamics by a rank-1 updated matrix system, we derived the analytical representations of the eigenmodes of the Jacobian matrix that cause the oscillation. Based on these analytical representations, we successfully derived the essential conditions for the oscillation in terms of the rate constants of the power stroke and the reversal stroke transitions of the molecular motor.

Deformable regions of interest with multiple points for tissue tracking in echocardiography.

By tracking echocardiography images more accurately and stably, we can better assess myocardial functions. In this paper, we propose a new tracking method with deformable Regions of Interest (ROIs) aiming at rational pattern matching. For this purpose we defined multiple tracking points for an ROI and regarded these points as nodes in the Meshfree Method to interpolate displacement fields.

Tailor-made heart simulation predicts the effect of cardiac resynchronization therapy in a canine model of heart failure.

Despite extensive studies on clinical indices for the selection of patient candidates for cardiac resynchronization therapy (CRT), approximately 30% of selected patients do not respond to this therapy. Herein, we examined whether CRT simulations based on individualized realistic three-dimensional heart models can predict the therapeutic effect of CRT in a canine model of heart failure with left bundle branch block. In four canine models of failing heart with dyssynchrony, individualized three-dimensional heart models reproducing the electromechanical activity of each animal were created based on the computer tomographic images.