Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
Open accessAbstract
A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied. We aim to compare pacing-induced electrical synchrony during conventional CRT, HBP, and LBP in RBBB patients with different conduction disturbances, and to investigate whether alternative ways of delivering LBP improve response to pacing. We simulated ventricular activation on twenty-four four-chamber heart geometries each including a His-Purkinje system with proximal right bundle branch block (RBBB). We simulated RBBB combined with left anterior and posterior fascicular blocks (LAFB and LPFB). Additionally, RBBB was simulated in the presence of slow conduction velocity (CV) in the myocardium, left ventricular (LV) or right ventricular (RV) His-Purkinje system, and whole His-Purkinje system. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (BIVAT-90). Compared to baseline, HBP significantly improved activation times for RBBB alone (BIVAT-90: 66.9 ± 5.5 ms vs. 42.6 ± 3.8 ms, p < 0.01), with LAFB (69.5 ± 5.0 ms vs. 58.1 ± 6.2 ms, p < 0.01), with LPFB (81.8 ± 6.6 ms vs. 62.9 ± 6.2 ms, p < 0.01), with slow myocardial CV (119.4 ± 11.4 ms vs. 97.2 ± 10.0 ms, p < 0.01) or slow CV in the whole His-Purkinje system (102.3 ± 7.0 ms vs. 75.5 ± 5.2 ms, p < 0.01). LBP was only effective in RBBB cases if combined with anodal capture of the RV septum myocardium (BIVAT-90: 66.9 ± 5.5 ms vs. 48.2 ± 5.2 ms, p < 0.01). CRT significantly reduced activation times in RBBB in the presence of severely slow RV His-Purkinje CV (95.1 ± 7.9 ms vs. 84.3 ± 9.3 ms, p < 0.01) and LPFB (81.8 ± 6.6 ms vs. CRT: 72.9 ± 8.6 ms, p < 0.01). Both CRT and HBP were ineffective with severely slow CV in the LV His-Purkinje system. HBP is effective in RBBB patients with otherwise healthy myocardium and Purkinje system, while CRT and LBP are ineffective. Response to LBP improves when LBP is combined with RV septum anodal capture. CRT is better than HBP only in patients with severely slow CV in the RV His-Purkinje system, while CV slowing of the whole His-Purkinje system and the myocardium favor HBP over CRT.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
These 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 [41]
The Introduction (page unavailable) says the models were used to study CRT and other pacing methods in heart-failure patients with right bundle branch block (RBBB), not left bundle branch block (LBBB). The Discussion, §4.1 Limitations (page unavailable), likewise describes the study as a comparison of pacing modalities in the presence of RBBB. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredIn 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 [41]
Materials and methods describes a cohort of 24 patient-derived heart meshes used in the simulations. The Limitations section says the models included synthetically generated His–Purkinje systems, but it does not describe a separate synthetic cohort; the meshes were also generated in a previous study rather than created here. (LLM, conf=0.85)
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 [41]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Total Excitation of the Isolated Human Heart
DURRER, D., van Dam, R. T., FREUD, G. E., Janse, M. J., MEIJLER, F. L., & ARZBAECHER, R. C. (1970) · Circulation · doi:10.1161/01.cir.41.6.899 · Cited by 1,779 · see citing works
Lustgarten, D. L., Crespo, E. M., Arkhipova-Jenkins, I., Lobel, R. M., Winget, J. F., Koehler, J. L., Liberman, E., & Sheldon, T. (2015) · Heart Rhythm · doi:10.1016/j.hrthm.2015.03.048 · Cited by 417 · see citing works
Mechanisms Underlying Conduction Slowing and Arrhythmogenesis in Nonischemic Dilated Cardiomyopathy
Akar, F. G., SPRAGG, D. D., Tunin, R. S., Kass, D. A., & Tomaselli, G. F. (2004) · Circulation Research · doi:10.1161/01.res.0000144125.61927.1c · Cited by 308 · see citing works
Neic, A., Campos, F. O., Prassl, A. J., Niederer, S., Bishop, M. J., Vigmond, E. J., & Plank, G. (2017) · Journal of Computational Physics · doi:10.1016/j.jcp.2017.06.020 · Cited by 192 · see citing works
Self-citationSharma, P. S., Naperkowski, A. M., Bauch, T. D., Chan, J. Y., Arnold, A. D., Whinnett, Z. I., Ellenbogen, K. A., & Vijayaraman, P. (2018) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.118.006613 · Cited by 171 · see citing works
Salden, F., LUERMANS, J. G. L. M., Westra, S. W., Weijs, B., Engels, E. B., Heckman, L. I. B., Lamerichs, L. J. M., Janssen, M. H. G., Clerx, K. J. H., Cornelussen, R. N., et al. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2019.11.040 · Cited by 143 · see citing works
A COMPARISON OF THE CONDUCTION VELOCITY IN CARDIAC TISSUES OF VARIOUS MAMMALS
Draper, M. H., & Mya-Tu, M. (1959) · Quarterly Journal of Experimental Physiology and Cognate Medical Sciences · doi:10.1113/expphysiol.1959.sp001379 · Cited by 112 · see citing works
Strocchi, M., Augustin, C. M., Gsell, M. A. F., Karabelas, E., Neic, A., Gillette, K., Razeghi, O., Prassl, A. J., Vigmond, E. J., Behar, J. M., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235145 · Cited by 112 · see citing works
Self-citationOno, N., Yamaguchi, T., Ishikawa, H., Arakawa, M., Takahashi, N., Saikawa, T., & Shimada, T. (2009) · Archivum histologicum japonicum · doi:10.1679/aohc.72.139 · Cited by 111 · see citing works
Sieniewicz, B., Gould, J., Porter, B., Sidhu, B. S., Teall, T., Webb, J., Carr-White, G., & Rinaldi, C. A. (2018) · Heart Failure Reviews · doi:10.1007/s10741-018-9734-8 · Cited by 105 · see citing works
Self-citationHara, H., Oyenuga, O. A., Tanaka, H., ADELSTEIN, E. C., Onishi, T., McNamara, D. M., SCHWARTZMAN, D. S., Saba, S., & Gorcsan, J. (2012) · European Heart Journal · doi:10.1093/eurheartj/ehs013 · Cited by 102 · see citing works
Strocchi, M., Lee, A. W. C., Neic, A., Bouyssier, J., Gillette, K., Plank, G., Elliott, M. K., Gould, J., Behar, J. M., Sidhu, B., et al. (2020) · Heart Rhythm · doi:10.1016/j.hrthm.2020.06.028 · Cited by 73 · see citing works
Self-citationHis Bundle Pacing: A New Strategy for Physiological Ventricular Activation
Lewis, A., Foley, P. W. X., Whinnett, Z. I., Keene, D., & Chandrasekaran, B. (2019) · Journal of the American Heart Association · doi:10.1161/jaha.118.010972 · Cited by 71 · see citing works
Gillette, K. K., Gsell, M. A. F., Bouyssier, J., Prassl, A. J., Neic, A., Vigmond, E. J., & Plank, G. (2021) · Annals of Biomedical Engineering · doi:10.1007/s10439-021-02825-9 · Cited by 71 · see citing works
Self-citationVijayaraman, P., Cano, Ó., Ponnusamy, S. S., Molina‐Lerma, M., Chan, J. Y., Padala, S. K., Sharma, P. S., Whinnett, Z. I., Herweg, B., Upadhyay, G. A., et al. (2022) · Heart Rhythm O2 · doi:10.1016/j.hroo.2022.05.004 · Cited by 64 · see citing works
Does Cardiac Resynchronization Therapy Benefit Patients With Right Bundle Branch Block
Auricchio, A., Lumens, J., & Prinzen, F. W. (2014) · Circulation Arrhythmia and Electrophysiology · doi:10.1161/circep.113.000628 · Cited by 61 · see citing works
Bryant, A. R., Wilton, S. B., Lai, M. P., & Exner, D. V. (2013) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2012.12.003 · Cited by 57 · see citing works
Ion Channel Subunit Expression Changes in Cardiac Purkinje Fibers
Maguy, A., Bouter, S. L., Comtois, P., Chartier, D., Villeneuve, L. R., Wakili, R., Nishida, K., & Nattel, S. (2009) · Circulation Research · doi:10.1161/circresaha.108.191809 · Cited by 54 · see citing works
A personalized real-time virtual model of whole heart electrophysiology
Gillette, K. K., Gsell, M. A. F., Strocchi, M., Grandits, T., Neic, A., Manninger, M., Scherr, D., Roney, C. H., Prassl, A. J., Augustin, C. M., et al. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.907190 · Cited by 41 · see citing works
Self-citationEffect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing
Strocchi, M., Gillette, K., Neic, A., Elliott, M. K., Wijesuriya, N., Mehta, V., Vigmond, E. J., Plank, G., Rinaldi, C. A., & Niederer, S. A. (2023) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.15847 · Cited by 35 · see citing works
Self-citationPastore, G., Morani, G., Maines, M., Marcantoni, L., Bolzan, B., Zanon, F., Noventa, F., CORBUCCI, G., Baracca, E., Picariello, C., et al. (2017) · EP Europace · doi:10.1093/europace/eux362 · Cited by 34 · see citing works
Wijesuriya, N., Elliott, M. K., Mehta, V. S., Sidhu, B. S., Behar, J. M., Niederer, S., & Rinaldi, C. A. (2022) · Heart Rhythm · doi:10.1016/j.hrthm.2022.02.018 · Cited by 27 · see citing works
Self-citationSalden, O. A. E., Vernooy, K., van Stipdonk, A. M. W., Cramer, M. J., Prinzen, F. W., & Meine, M. (2020) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2019.11.018 · Cited by 18 · see citing works
Lin, J., Dai, Y., Wang, H., Li, Y., Chen, K., & Zhang, S. (2019) · HeartRhythm Case Reports · doi:10.1016/j.hrcr.2019.10.007 · Cited by 13 · see citing works
Henin, M., Ragy, H. I., Mannion, J., David, S., Refila, B., & Boles, U. (2020) · Cardiology Research · doi:10.14740/cr989 · Cited by 8 · see citing works
Naruse, Y., Seo, Y., Murakoshi, N., Ishizu, T., Sekiguchi, Y., & Aonuma, K. (2014) · Journal of Cardiology Cases · doi:10.1016/j.jccase.2013.12.013 · Cited by 3 · see citing works
Dennis, M. J., SPARKS, P. B., & Capitani, G. (2022) · Indian Pacing and Electrophysiology Journal · doi:10.1016/j.ipej.2022.04.002 · Cited by 2 · see citing works
Flagged first, then by citations
1 of the 28 references couldn’t be matched to a known paper.
Research works printed but not linked: 1
- Arnold A. D. Shun-Shin M. J. Keene D. Howard J. P. Afzal Sohaib S. M. Wright I. J. (2018). His resynchronization therapy vs. biventricular pacing for heart failure with LBBB: A within-patient comparison of effects on acute haemodynamic function and ventricular activation. EP Europace 20 (4), iv25. 10.1093/europace/euy201.001 · DOI
Cited by
Sorted by citations
Credibility assessment of in silico clinical trials for medical devices
Pathmanathan, P., Aycock, K., Badal, A., Bighamian, R., Bodner, J., Craven, B. A., & Niederer, S. (2024) · PLOS Computational Biology · doi:10.1371/journal.pcbi.1012289 · Cited by 62 · see citing works
Self-citationDigital twinning of cardiac electrophysiology for congenital heart disease
Salvador, M., Kong, F., Peirlinck, M., Parker, D. W., Chubb, H., Dubin, A. M., & Marsden, A. L. (2024) · Journal of The Royal Society Interface · doi:10.1098/rsif.2023.0729 · Cited by 29 · see citing works
Domenichini, G., Bloa, M. L., Castillo, C. T., Graf, D., Carroz, P., Ascione, C., Porretta, A. P., Pascale, P., & Pruvot, E. J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12196288 · Cited by 18 · see citing works
Cardiac Resynchronisation with Conduction System Pacing
Ezzeddine, F. M., Leon, I. G., & Cha, Y. (2023) · Arrhythmia & Electrophysiology Review · doi:10.15420/aer.2023.03 · Cited by 14 · see citing works
Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing
Strocchi, M., Wijesuriya, N., Mehta, V. S., de Vere, F., Rinaldi, C. A., & Niederer, S. (2023) · Journal of Cardiovascular Translational Research · doi:10.1007/s12265-023-10453-y · Cited by 10 · see citing works
Self-citationStrocchi, M., Wijesuriya, N., Elliott, M. K., Gillette, K., Neic, A., Mehta, V., Vigmond, E. J., Plank, G., Rinaldi, C. A., & Niederer, S. A. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.1049214 · Cited by 8 · see citing works
Self-citationStrocchi, M., Samways, J., Naraen, A., Ali, N., Shun-Shin, M. J., Gillette, K. K., Rinaldi, C. A., Arnold, A. D., Plank, G., Vigmond, E. J., et al. (2025) · EP Europace · doi:10.1093/europace/euaf089 · Cited by 9 · see citing works
Self-citationRecruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart
Chen, Z., Zhou, X., Ma, X., & Chen, K. (2022) · Frontiers in Physiology · doi:10.3389/fphys.2022.1045740 · Cited by 7 · see citing works
Digital twinning of cardiac electrophysiology for congenital heart diseasePreprint
Salvador, M., Kong, F., Peirlinck, M., Parker, D. W., Chubb, H., Dubin, A. M., & Marsden, A. L. (2023) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2023.11.27.568942 · Cited by 6 · see citing works
Nesterova, T., Kabak, V. Y., Lebedev, D. S., & Solovyova, O. E. (2024) · Russian Journal of Cardiology · doi:10.15829/1560-4071-2024-6194 · Cited by 3 · see citing works
Toth, A. Z., Nagy, L., Jenei, C., Ráduly, A. P., Sándorfi, G., Szabó, K. M., Kiss, A., Nagy, L. T., Szilágyi, G. I., & Csanádi, Z. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm15010232 · Cited by 1 · see citing works
Savel, R. H. (2024) · Critical Care Medicine · doi:10.1097/ccm.0000000000006479
Personalization of parameters of electro-physiological model of the human heart
Kabak, V. Y., Rokeakh, R., Nesterova, T., Dzhigil, M., Chumarnaya, T. V., Dokuchaev, A., & Solovyova, O. E. (2025) · Russian Journal of Numerical Analysis and Mathematical Modelling · doi:10.1515/rnam-2025-0026
Coupled Eikonal Problems to Model Cardiac Reentries in Purkinje Network and Myocardium
Brunati, S., Bucelli, M., Piersanti, R., Dede’, L., & Vergara, C. (2026) · SIAM Journal on Scientific Computing · doi:10.1137/25m1723487 · Cited by 1 · see citing works
Modeling of the cardiac conduction system
Vigmond, E. J. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-24142-0.00006-0
Self-citationKariman, M., Augustin, C. M., & Plank, G. (2026) · Frontiers in Physiology · doi:10.3389/fphys.2026.1818421
Self-citation
- Authors
- Strocchi, M., Gillette, K., Neic, A., Elliott, M. K., Wijesuriya, N., Mehta, V., Vigmond, E. J., Plank, G., Rinaldi, C. A., & Niederer, S. A.
- Affiliations
- King's College London (GB)
- Medical University of Graz (AT)
- Université de Bordeaux (FR)
- Corresponding author
- Strocchi, Marina
- ORCID
- Venue
- Frontiers in Physiology
- Publisher
- Frontiers Media SA
- Published
- 2022-09-21
- Volume
- 13
- Pages
- 1011566-1011566
- ISSN
- 1664-042X (ISSN-L)
- PMC
- PMC9532840
- OpenAlex
- W4296738439
- Cited by
- 16
- References
- 28
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 2
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Physiology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Wellcome (WT 203148/Z/16/Z)
- Engineering and Physical Sciences Research Council (WT 203148/Z/16/Z EP/P01268X/1)
- National Institutes of Health (R01-HL152256)
- European Research Council (453 (864055))
- British Heart Foundation (RG/20/4/34803)
- 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
- right bundle branch block, cardiac resynchronization therapy, His bundle pacing, His-Purkinje system, ventricular activation, left anterior fascicular block, left posterior fascicular block, atrial fibrillation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
