Effects of cardiac growth on electrical dyssynchrony in the single ventricle patient

Abstract

Single ventricle patients, including those with hypoplastic left heart syndrome (HLHS), typically undergo three palliative heart surgeries culminating in the Fontan procedure. HLHS is associated with high rates of morbidity and mortality, and many patients develop arrhythmias, electrical dyssynchrony, and eventually ventricular failure. However, the correlation between ventricular enlargement and electrical dysfunction in HLHS physiology remains poorly understood. Here we characterize the relationship between growth and electrophysiology in HLHS using computational modeling. We integrate a personalized finite element model, a volumetric growth model, and a personalized electrophysiology model to perform controlled in silico experiments. We show that right ventricle enlargement negatively affects QRS duration and interventricular dyssynchrony. Conversely, left ventricle enlargement can partially compensate for this dyssynchrony. These findings have potential implications on our understanding of the origins of electrical dyssynchrony and, ultimately, the treatment of HLHS patients.

Keywords:

• Hypoplastic left heart syndrome
• congenital heart disease
• cardiac electrophysiology
• growth and remodeling
• dyssynchrony

Disclosure statement

The authors report that there are no competing interests to declare.

Additional information

Funding

This work was supported by the NSF Grant SI2-SSI 1663671 ‘The SimCardio open source multi-physics cardiac modeling package’ and the NIH Grant R01 HL131823 ‘A new framework for understanding the mechanisms of diastolic dysfunction’.