Key result
Endocardial electrode positioning at three specific pairs of locations provided an optimal outcome for maximizing cardiac resynchronization therapy efficiency in 35 patient-specific in-silico models.
Why the study?
About 30% of CRT implantations fail to improve heart performance, prompting investigation into whether endocardial electrode positioning could optimize CRT efficiency.
Does optimal endocardial electrode positioning improve CRT efficiency compared to conventional epicardial placement in computational models?
Does optimal endocardial electrode positioning improve CRT efficiency compared to conventional epicardial placement in computational models?
In-silico modeling identifies three optimal endocardial electrode position pairs that may enhance CRT response in heart failure patients.
Optimal endocardial sites may reduce CRT nonresponse; leaves open clinical translation from in-silico models.
Cardiac resynchronization therapy (CRT) is one of the recommended therapies for patients with chronic heart failure. Unfortunately, about 30% of CRT device implantation can not improve heart performance. Modern wireless pacemakers and alternative approach for endocardial LV leads can apply pacing stimulus at an arbitrary location in the left ventricular endocardial wall. This provides an opportunity to increase the efficiency of CRT and outperform the conventional CRT procedure with LV CRT lead position at the epicardial surface of the left ventricular wall. In this in-silico study, we analyze the possibility for an optimal position of the electrodes at the endocardial surfaces of the right ventricle and left ventricle for the maximal efficiency of CRT. Computations are performed with 35 patient-specific models of the human heart, lungs, and torso. Eikonal and ionic TP06 models are used for modelling the myocardial electrophysiology. As a result, we found three pairs of electrode positions that can provide an optimal outcome for a major part of the patient-specific models.
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Bazhutina et al. (2020) studied chronic heart failure (n=35). Endocardial electrode positioning vs. Conventional epicardial CRT was evaluated on Maximal efficiency of CRT. Endocardial electrode positioning at three specific pairs of locations provided an optimal outcome for maximizing cardiac resynchronization therapy efficiency in 35 patient-specific in-silico models.
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