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Selected Publication:
SHR Neuro Cancer Cardio Lipid Metab Microb
Strocchi, M; Samways, JW; Naraen, A; Ali, N; Shun-Shin, MJ; Gillette, K; Rinaldi, CA; Arnold, AD; Plank, G; Vigmond, EJ; Whinnett, ZI; Niederer, SA.
An in silico guide for ventriculo-ventricular delay programming for left bundle branch-optimized cardiac resynchronization therapy.
EUROPACE. 2025; 27(5):
Doi: 10.1093/europace/euaf089
[OPEN ACCESS]
Web of Science
PubMed
FullText
FullText_MUG
- Co-authors Med Uni Graz
- Gillette Karli
- Plank Gernot
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- Abstract:
- AIMS: Left bundle branch pacing (LBBP)-optimized cardiac resynchronization therapy (LOT-CRT) can improve left ventricular (LV) activation when LBBP alone or conventional biventricular pacing are ineffective. However, the optimal programming settings for ventriculo-ventricular delay (VVD) for LOT-CRT are unknown. We aim to investigate how to optimally program VVD for LOT-CRT in the presence of various LV conduction substrates using computational modelling. METHODS AND RESULTS: We simulated ventricular activation on 24 anatomies and validated the model against clinical data. Diffuse LV conduction system and intra-myocardial delay were simulated by slowing the conduction velocity of the LV His-Purkinje system and myocardium, respectively, alone or in combination with proximal left bundle branch block (LBBB). We simulated LOT-CRT with selective or myocardial capture (LV septal pacing, LVSP) with VVD ranging between -100 ms (LBBP/LVSP ahead) and +100 ms [LV epicardial lead (LVepiP), ahead]. Response was quantified with 95% LV activation times (LVAT95). In the presence of diffuse LV conduction system delay, the optimal VVD for LOT-CRT was always negative (LBBB: -42.5 ± 6.6 ms; no LBBB: -36.2 ± 5.6 ms), as delivering LBBP ahead of LVepiP compensates for the slow LV His-Purkinje. In the presence of LV intra-myocardial disease, the shortest LVAT95 with LOT-CRT was achieved by pacing the coronary sinus LV first (optimal VVD for LBBB: 23.3 ± 8.5 ms; no LBBB: 79.2 ± 18.0 ms). The type of capture for LOT-CRT affected the optimal VVD, with myocardial capture favouring negative VVDs (LVSP ahead). CONCLUSION: The optimal VVD for LOT-CRT depends on the mechanism of delayed LV activation and type of capture achieved, highlighting the importance of VVD optimization.
- Find related publications in this database (using NLM MeSH Indexing)
- Humans - administration & dosage
- Cardiac Resynchronization Therapy - methods
- Bundle-Branch Block - physiopathology, therapy, diagnosis
- Bundle of His - physiopathology
- Models, Cardiovascular - administration & dosage
- Action Potentials - administration & dosage
- Computer Simulation - administration & dosage
- Ventricular Function, Left - administration & dosage
- Heart Failure - physiopathology, therapy, diagnosis
- Heart Ventricles - physiopathology
- Heart Rate - administration & dosage
- Time Factors - administration & dosage
- Treatment Outcome - administration & dosage
- Patient-Specific Modeling - administration & dosage
- Find related publications in this database (Keywords)
- Cardiac resynchronization therapy
- Ventriculo-ventricular delay
- Conduction substrate
- Conduction system pacing
- Computational model