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SHR Neuro Cancer Cardio Lipid Metab Microb

Strocchi, M; Gillette, K; Neic, A; Elliott, MK; Wijesuriya, N; Mehta, V; Vigmond, EJ; Plank, G; Rinaldi, CA; Niederer, SA.
Effect of scar and His-Purkinje and myocardium conduction on response to conduction system pacing.
J Cardiovasc Electrophysiol. 2023; 34(4):984-993 Doi: 10.1111/jce.15847 [OPEN ACCESS]
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Co-authors Med Uni Graz
Gillette Karli
Neic Aurel-Vasile
Plank Gernot

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INTRODUCTION: Conduction system pacing (CSP), in the form of His bundle pacing (HBP) or left bundle branch pacing (LBBP), is emerging as a valuable cardiac resynchronization therapy (CRT) delivery method. However, patient selection and therapy personalization for CSP delivery remain poorly characterized. We aim to compare pacing-induced electrical synchrony during CRT, HBP, LBBP, HBP with left ventricular (LV) epicardial lead (His-optimized CRT [HOT-CRT]), and LBBP with LV epicardial lead (LBBP-optimized CRT [LOT-CRT]) in patients with different conduction disease presentations using computational modeling. METHODS: We simulated ventricular activation on 24 four-chamber heart geometries, including His-Purkinje systems with proximal left bundle branch block (LBBB). We simulated septal scar, LV lateral wall scar, and mild and severe myocardium and LV His-Purkinje system conduction disease by decreasing the conduction velocity (CV) down to 70% and 35% of the healthy CV. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (90% of biventricular activation time [BIVAT-90]). RESULTS: Severe LV His-Purkinje conduction disease favored CRT (BIVAT-90: HBP 101.5 ± 7.8 ms vs. CRT 93.0 ± 8.9 ms, p < .05), with additional electrical synchrony induced by HOT-CRT (87.6 ± 6.7 ms, p < .05) and LOT-CRT (73.9 ± 7.6 ms, p < .05). Patients with slow myocardium CV benefit more from CSP compared to CRT (BIVAT-90: CRT 134.5 ± 24.1 ms; HBP 97.1 ± 9.9 ms, p < .01; LBBP: 101.5 ± 10.7 ms, p < .01). Septal but not lateral wall scar made CSP ineffective, while CRT was able to resynchronize the ventricles in the presence of septal scar (BIVAT-90: baseline 119.1 ± 10.8 ms vs. CRT 85.1 ± 14.9 ms, p < .01). CONCLUSION: Severe LV His-Purkinje conduction disease attenuates the benefits of CSP, with additional improvements achieved with HOT-CRT and LOT-CRT. Septal but not lateral wall scars make CSP ineffective.
Find related publications in this database (using NLM MeSH Indexing)
Humans - administration & dosage
Bundle of His - administration & dosage
Cicatrix - administration & dosage
Electrocardiography - methods
Heart Conduction System - administration & dosage
Myocardium - administration & dosage

Find related publications in this database (Keywords)
cardiac resynchronization therapy
conduction system pacing
heart failure
His bundle pacing
left bundle branch block
left bundle pacing
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