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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
- Source :
- Heart rhythm. 17(11)
- Publication Year :
- 2020
-
Abstract
- 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.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.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.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.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.
- Subjects :
- Male
medicine.medical_specialty
Bundle of His
Cardiac Catheterization
Epicardial pacing
medicine.medical_treatment
Heart Ventricles
Bundle-Branch Block
Cardiac resynchronization therapy
030204 cardiovascular system & hematology
Ventricular Function, Left
Cardiac Resynchronization Therapy
03 medical and health sciences
Electrocardiography
0302 clinical medicine
Physiology (medical)
Internal medicine
medicine
Humans
cardiovascular diseases
030212 general & internal medicine
Lead (electronics)
Aged
Left bundle branch block
business.industry
Av delay
medicine.disease
Bundle
Heart failure
cardiovascular system
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Lateral wall
Endocardium
Subjects
Details
- ISSN :
- 15563871
- Volume :
- 17
- Issue :
- 11
- Database :
- OpenAIRE
- Journal :
- Heart rhythm
- Accession number :
- edsair.doi.dedup.....866442f6601fe49eb13618edebe82fa9