Marina Strocchi1, Angela W C Lee2, Aurel Neic3, Julien Bouyssier4, Karli Gillette5, Gernot Plank5, Mark K Elliott6, Justin Gould6, Jonathan M Behar6, Baldeep Sidhu6, Vishal Mehta6, Martin J Bishop2, Edward J Vigmond4, Christopher A Rinaldi6, Steven A Niederer2. 1. School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom. Electronic address: marina.strocchi@kcl.ac.uk. 2. School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom. 3. NumeriCor GmbH, Graz, Austria. 4. IHU LIRYC Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; University of Bordeaux, IMB, Talence, France. 5. Division of Biophysics, Medical University of Graz, Graz, Austria. 6. School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom.
Abstract
BACKGROUND: His-bundle pacing (HBP) and left bundle pacing (LBP) are emerging as novel delivery methods for cardiac resynchronization therapy (CRT) in heart failure patients with left bundle branch block (LBBB). HBP and LBP have never been compared to biventricular endocardial (BiV-endo) pacing. Furthermore, there are indications of negative effects of LBP on right ventricular (RV) activation times (ATs), but these effects have not been quantified. OBJECTIVE: The purpose of this study was to compare changes in ventricular activation induced by HBP, LBP, left ventricular (LV) septal pacing, BiV-endo, and biventricular epicardial (BiV-epi) pacing using computer simulations. METHODS: We simulated ventricular activation on 24 four-chamber heart meshes inclusive of the His-Purkinje network in the presence of LBBB. We simulated BiV-epi pacing, BiV-endo pacing with left ventricular (LV) lead at the lateral wall, BiV-endo pacing with LV lead at the LV septum, HBP, and LBP. RESULTS: HBP was superior to BiV-endo and BiV-epi in terms of reduction in LV ATs and interventricular dyssynchrony (P <.05). LBP reduced LV ATs but not interventricular dyssynchrony compared to BiV-epi and BiV-endo pacing. RV latest AT was higher with LBP than with HBP (141.3 ± 10.0 ms vs 111.8 ± 10.4 ms). Optimizing AV delay during LBP reduced RV latest AT (104.7 ± 8.7 ms) and led to comparable response to HBP. In case of complete AV block, BiV-endo septal pacing was equivalent to LBP. CONCLUSION: HBP is superior to BiV-epi and BiV-endo. To achieve comparable response to HBP, AV delay optimization during LBP is required in order to reduce RV ATs.
BACKGROUND: His-bundle pacing (HBP) and left bundle pacing (LBP) are emerging as novel delivery methods for cardiac resynchronization therapy (CRT) in heart failurepatients with left bundle branch block (LBBB). HBP and LBP have never been compared to biventricular endocardial (BiV-endo) pacing. Furthermore, there are indications of negative effects of LBP on right ventricular (RV) activation times (ATs), but these effects have not been quantified. OBJECTIVE: The purpose of this study was to compare changes in ventricular activation induced by HBP, LBP, left ventricular (LV) septal pacing, BiV-endo, and biventricular epicardial (BiV-epi) pacing using computer simulations. METHODS: We simulated ventricular activation on 24 four-chamber heart meshes inclusive of the His-Purkinje network in the presence of LBBB. We simulated BiV-epi pacing, BiV-endo pacing with left ventricular (LV) lead at the lateral wall, BiV-endo pacing with LV lead at the LV septum, HBP, and LBP. RESULTS: HBP was superior to BiV-endo and BiV-epi in terms of reduction in LV ATs and interventricular dyssynchrony (P <.05). LBP reduced LV ATs but not interventricular dyssynchrony compared to BiV-epi and BiV-endo pacing. RV latest AT was higher with LBP than with HBP (141.3 ± 10.0 ms vs 111.8 ± 10.4 ms). Optimizing AV delay during LBP reduced RV latest AT (104.7 ± 8.7 ms) and led to comparable response to HBP. In case of complete AV block, BiV-endo septal pacing was equivalent to LBP. CONCLUSION: HBP is superior to BiV-epi and BiV-endo. To achieve comparable response to HBP, AV delay optimization during LBP is required in order to reduce RV ATs.
Authors: Nadeev Wijesuriya; Mark K Elliott; Vishal Mehta; Baldeep S Sidhu; Marina Strocchi; Jonathan M Behar; Steven Niederer; Christopher A Rinaldi Journal: Front Physiol Date: 2022-06-06 Impact factor: 4.755
Authors: Baldeep S Sidhu; Justin Gould; Mark K Elliott; Vishal Mehta; Steven Niederer; Christopher A Rinaldi Journal: Arrhythm Electrophysiol Rev Date: 2021-04
Authors: Kazi T Haq; Nichole M Rogovoy; Jason A Thomas; Christopher Hamilton; Katherine J Lutz; Ashley Wirth; Aron B Bender; David M German; Ryle Przybylowicz; Peter van Dam; Thomas A Dewland; Khidir Dalouk; Eric Stecker; Babak Nazer; Peter M Jessel; Karen S MacMurdy; Ignatius Gerardo E Zarraga; Bassel Beitinjaneh; Charles A Henrikson; Merritt Raitt; Cristina Fuss; Maros Ferencik; Larisa G Tereshchenko Journal: Heart Rhythm O2 Date: 2021-06-29
Authors: Karli Gillette; Matthias A F Gsell; Julien Bouyssier; Anton J Prassl; Aurel Neic; Edward J Vigmond; Gernot Plank Journal: Ann Biomed Eng Date: 2021-08-24 Impact factor: 3.934
Authors: Caroline Mendonca Costa; Philip Gemmell; Mark K Elliott; John Whitaker; Fernando O Campos; Marina Strocchi; Aurel Neic; Karli Gillette; Edward Vigmond; Gernot Plank; Reza Razavi; Mark O'Neill; Christopher A Rinaldi; Martin J Bishop Journal: Comput Biol Med Date: 2021-11-26 Impact factor: 4.589
Authors: Marina Strocchi; Karli Gillette; Aurel Neic; Mark K Elliott; Nadeev Wijesuriya; Vishal Mehta; Edward J Vigmond; Gernot Plank; Christopher A Rinaldi; Steven A Niederer Journal: Front Physiol Date: 2022-09-21 Impact factor: 4.755