In Silico Closed-Loop System for the Assessment of Cardiac Pacing Algorithms

In this work, we report on the application of a closed-loop system, composed of a 2D reaction-diffusion heart model and a pace-maker model, for assessing pacemaker-heart interactions. To demonstrate the potential of our approach, we replicated a clinical case report in which a ventricular pacing-minimizing strategy promoted the onset of Pacemaker-Mediated Tachycardia (PMT). To replicate the clinical case, we simulated an atrioventricular (AV) block condition and set the same pacemaker programming reported in the clinical case study. Our study aims to show the usability and potential of our framework by exploring different pacemaker settings coupled with specific electro-physiological heart conditions, thus allowing the assessment of the safety and efficacy of a particular pacing algorithm. The results from our heart model highlighted that the refractoriness of the AV node, in addition to the pacemaker setting (e.g., AV delay and Post Ventricular Atrial Refractory period), plays a crucial role in the onset of PMTs in patients with pacemakers programmed with an AV delay hysteresis algorithm. We believe that our closed-loop system could represent a valuable auxiliary tool for a preliminary assessment and comparison of various pacing algorithms.