Model-based analysis of the autonomic response to head-up tilt testing in Brugada syndrome

• Published in: Computers in biology and medicine Vol. 103; pp. 82 - 92
• Main Authors: Calvo, Mireia, Le Rolle, Virginie, Romero, Daniel, Béhar, Nathalie, Gomis, Pedro, Mabo, Philippe, Hernández, Alfredo I.
• Format: Journal Article Publication
• Language: English
• Published: United States Elsevier Ltd 01.12.2018; Elsevier Limited; Elsevier
• Subjects: Autonomic nervous system; Autonomic nervous system Brugada syndrome Physiological model Sensitivity analysis Parameter identification; Baroreceptors; Bioengineering; Blood pressure; Brugada syndrome; Cardiovascular system; Computer Science; Electrocardiography; Engineering Sciences; Enginyeria biomèdica; Etiology; Heart rate; Life Sciences; Mathematical models; Modeling and Simulation; Modulation; Muscle contraction; Parameter identification; Parameter sensitivity; Patients; Physiological model; Reflexes; Risk; Sensitivity analysis; Signal and Image processing; Sistema nerviós autònom; Ventricle; Àrees temàtiques de la UPC; Sensitivity analysis; Brugada syndrome; Parameter identification; Autonomic nervous system; Physiological model
• ISSN: 0010-4825; 1879-0534
• DOI: 10.1016/j.compbiomed.2018.10.007

The etiology of Brugada syndrome (BS) is complex and multifactorial, making risk stratification in this population a major challenge. Since changes in the autonomic modulation of these patients are commonly related to arrhythmic events, we analyze in this work whether the response to head-up tilt (HUT) testing on this population may provide useful, complementary information for risk stratification. In order to perform this analysis, a coupled physiological model integrating the cardiac electrical activity, the cardiovascular system and the baroreceptors reflex control of the autonomic function, in response to HUT is proposed. A sensitivity analysis was performed, based on a screening method, evidencing the influence of cardiovascular parameters on blood pressure and of baroreflex regulation on heart rate. The most sensitive parameters have been identified on a set of 20 subjects (8 controls and 12 BS patients), so as to assess subject-specific model parameters. According to the results, controls showed an increased sympathetic modulation after tilting, as well as a reduced left ventricular contractility was observed in symptomatic, with respect to asymptomatic BS patients. These results provide new insights regarding the autonomic mechanisms regulating the cardiovascular system in BS which might be used as a complementary source of information, along with classical electrophysiological parameters, for BS risk stratification. •Blood pressure is mainly influenced by cardiovascular parameters.•Heart rate is mostly modulated by baroreflex regulation.•Brugada syndrome patients show a decreased sympathetic modulation after tilting.•A reduced left ventricular contractility is observed in symptomatic patients.