In computer simulations, His-bundle pacing was superior to biventricular endocardial and epicardial pacing in reducing left ventricular activation times and interventricular dyssynchrony (P<.05).
Does His-bundle and left bundle pacing improve electrical synchrony compared to biventricular pacing in simulated LBBB?
Computer simulations suggest that His-bundle pacing and AV-optimized left bundle pacing provide superior electrical resynchronization compared to traditional biventricular pacing in LBBB.
valor p: p=<.05
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.
Strocchi et al. (2020) studied Heart failure with left bundle branch block (LBBB) (n=24). His-bundle pacing (HBP) and left bundle pacing (LBP) vs. Biventricular endocardial (BiV-endo) and epicardial (BiV-epi) pacing was evaluated on Reduction in left ventricular activation times and interventricular dyssynchrony (p=<.05). In computer simulations, His-bundle pacing was superior to biventricular endocardial and epicardial pacing in reducing left ventricular activation times and interventricular dyssynchrony (P<.05).