His-bundle and left bundle pacing with optimized atrioventricular delay achieve superior electrical synchrony over endocardial and epicardial pacing in left bundle branch block patients
Open accessAbstract
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.
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In these studies, both subject-specific and synthetic cohorts were created.
“In these studies, both subject-specific and synthetic cohorts were created.”
From Credibility assessment of in silico clinical trials for medical devices (2024) · cites this paper as [42]
The Study limitations section (page unavailable) describes a cohort of 24 patient-specific anatomical models with synthetically defined His-Purkinje networks. This supports the use of subject-specific models and synthetic components, but not the creation of a separate synthetic cohort. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSynthetic patients were created from the subject-specific virtual patients by introducing different presentations of electrophysiology pathologies in each patient.
“Synthetic patients were then created from the subject-specific virtual patients, by introducing different presentations of electrophysiology pathologies in each patient (case B in Fig 1).”
From Credibility assessment of in silico clinical trials for medical devices (2024) · cites this paper as [42]
The Anatomic models section (page not provided) says the authors built 24 heart models and simulated LBBB by disconnecting the left-ventricular Purkinje network. The Study limitations section describes patient-specific anatomic models with synthetic His–Purkinje networks. This supports creating virtual patients with a simulated pathology, but not introducing different electrophysiological pathologies in each patient. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThese models were used in [41-43] to study the efficacy of different cardiac resynchronization therapy pacing protocols for heart failure patients with left bundle branch block.
“These models were used in [41–43] to study the efficacy of different cardiac resynchronization therapy (CRT) pacing protocols for heart failure patients with left bundle branch block (LBBB).”
From Credibility assessment of in silico clinical trials for medical devices (2024) · cites this paper as [42]
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- Authors
- Strocchi, M., Lee, A. W. C., Neic, A., Bouyssier, J., Gillette, K., Plank, G., Elliott, M. K., Gould, J., Behar, J. M., Sidhu, B., Mehta, V., Bishop, M. J., Vigmond, E. J., Rinaldi, C. A., & Niederer, S. A.
- Affiliations
- King's College London (GB)
- Université de Bordeaux (FR)
- Medical University of Graz (AT)
- Corresponding author
- Strocchi, Marina
- ORCID
- Venue
- Heart Rhythm
- Publisher
- Elsevier BV
- Published
- 2020-11
- Volume
- 17
- Issue
- 11
- Pages
- 1922-1929
- ISSN
- 1547-5271 (ISSN-L)
- OpenAlex
- W3037700092
- Cited by
- 73
- References
- 35
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 14 · 2023: 16 · 2022: 13 · 2021: 14 · 2020: 2
- FWCI
- 6.96
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Heart Rhythm (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- British Heart Foundation (PG/13/37/30280, PG/15/91/31812)
- Agence Nationale de la Recherche (ANR-10-IAHU-04)
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research (ANR 15 CMED–0003 01)
- Engineering and Physical Sciences Research Council (EP/L015226/1, EP/M012492/1, EP/P01268X/1, NS/A000049/1)
- National Institute for Health and Care Research
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- His bundle pacing, left bundle branch block, cardiac resynchronization therapy, atrioventricular delay optimization, ventricular activation time, interventricular dyssynchrony, epicardial pacing, endocardial pacing, heart failure
- MeSH terms
- Aged, Bundle of His, Bundle-Branch Block, Electrocardiography, Endocardium, Female, Cardiac Catheterization, Heart Ventricles, Humans, Male, Ventricular Function, Left, Cardiac Resynchronization Therapy
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