Pranav Bhagirath

144 Chapter 7 Simulations The simulations of sinus rhythm performed on the computational meshes generated reliable results when compared to measurements reported in the literature [13] . Simulations performed on the personalized meshes incorporating virtual edema and scar resulted in a different activation pattern with delayed conduction and conduction block respectively. These observations illustrate the wide range of simulations which can be obtained utilizing this simulation model. This can be clinically relevant for patients presenting with arrhythmias with a history of a disease associated with fibrosis such as myocardial infarction and myocarditis. Whole-heart computational model Although only a few pathologies involve the atria and ventricles simultaneously, a combined assessment remains relevant for a comprehensive study of atrio-ventricular electro-mechanical coupling and electrical interaction. The atrial contraction presents such an example. It has been reported that pressure modulation due to atrial contractions can remotely alter the electrical behavior and activation pattern of the ventricular myocytes [15,16] . A whole-heart model is required to incorporate such complex relations and to provide physiologically accurate simulations. Limitations The simulations performed in this study used a standardized set of epicardial potentials recorded in a structurally normal human heart. Furthermore, the currently used simulation algorithm applied fixed conduction velocities for the cardiac volumes. However, the aim of the current study was to develop a clinically applicable and reliable method for isochrones generation. The evaluation of this algorithm could be successfully performed using one set (atrial and ventricular) of epicardial potentials. The generated simulation results were accurate for all subjects when compared to previous descriptions in the literature. Therefore, the absence of patient specific epicardial potentials and usage of a fixed conduction model was not considered as a limitation. The customized meshes were constructed to test the feasibility of incorporating tissue properties. The conductivity and speed values for edema and scar tissue were based on estimates. Although, this can be considered as a substantial limitation, the simulations with patient-specific geometries (incorporating scar and edema) demonstrated realistic results, and underline the feasibility of the simulation algorithm.