His Bundle Pacing but not Left Bundle Pacing Corrects Septal Flash in Left Bundle Branch Block Patients

Strocchi, Marina; Neic, Aurel; Gsell, Matthias A. F.; Augustin, Christoph M.; Bouyssier, Julien; Gillette, Karli; Elliot, Mark; Gould, Justin; Behar, Jonathan M.; Sidhu, Baldeep S.; Bishop, Martin J.; Vigmond, Edward J.; Rinaldi, Christopher A.; Niederer, Steven

doi:10.22489/cinc.2020.030

Cited by 4 publications

(2 citation statements)

References 9 publications

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“…Current evidence, especially with regards to the role of CSP in non-response, is limited to in silico studies and observational studies. Strocchi et al (2020) performed an in silico study examining ventricular activation times on 24 four chamber heart meshes in the presence of simulated left bundle branch block (LBBB). They simulated BiV epicardial and BiV endocardial pacing, as well as HBP and LBBAP.…”

Section: Conduction System Pacingmentioning

confidence: 99%

Pacing interventions in non-responders to cardiac resynchronization therapy

et al. 2023

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Non-responders to Cardiac Resynchronization Therapy (CRT) represent a high-risk, and difficult to treat population of heart failure patients. Studies have shown that these patients have a lower quality of life and reduced life expectancy compared to those who respond to CRT. Whilst the first-line treatment for dyssynchronous heart failure is “conventional” biventricular epicardial CRT, a range of novel pacing interventions have emerged as potential alternatives. This has raised the question whether these new treatments may be useful as a second-line pacing intervention for treating non-responders, or indeed, whether some patients may benefit from these as a first-line option. In this review, we will examine the current evidence for four pacing interventions in the context of treatment of conventional CRT non-responders: CRT optimization; multisite left ventricular pacing; left ventricular endocardial pacing and conduction system pacing.

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Section: Conduction System Pacingmentioning

confidence: 99%

Pacing interventions in non-responders to cardiac resynchronization therapy

et al. 2023

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“…Recent methodological advances in terms of both anatomical and functional twinning workflows suggest that streamlined generation of CDTs at scale is becoming feasible. 4,13,21,28 Of pivotal importance for a sound mechanistic representation of cardiac EP is the consideration of effects mediated by the His-Purkinje system (HPS) in the ventricles. Computational models that integrate a priori knowledge of the HPS and replicate QRS complexes in all electrocardiogram (ECG) leads can be considered likely and plausible approximations of a given patient's EP.…”

Section: Introductionmentioning

confidence: 99%

Automated Framework for the Inclusion of a His–Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology

et al. 2021

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Personalized models of cardiac electrophysiology (EP) that match clinical observation with high fidelity, referred to as cardiac digital twins (CDTs), show promise as a tool for tailoring cardiac precision therapies. Building CDTs of cardiac EP relies on the ability of models to replicate the ventricular activation sequence under a broad range of conditions. Of pivotal importance is the His–Purkinje system (HPS) within the ventricles. Workflows for the generation and incorporation of HPS models are needed for use in cardiac digital twinning pipelines that aim to minimize the misfit between model predictions and clinical data such as the 12 lead electrocardiogram (ECG). We thus develop an automated two stage approach for HPS personalization. A fascicular-based model is first introduced that modulates the endocardial Purkinje network. Only emergent features of sites of earliest activation within the ventricular myocardium and a fast-conducting sub-endocardial layer are accounted for. It is then replaced by a topologically realistic Purkinje-based representation of the HPS. Feasibility of the approach is demonstrated. Equivalence between both HPS model representations is investigated by comparing activation patterns and 12 lead ECGs under both sinus rhythm and right-ventricular apical pacing. Predominant ECG morphology is preserved by both HPS models under sinus conditions, but elucidates differences during pacing.

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Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing

Strocchi,

Wijesuriya,

Mehta

et al. 2023

J. of Cardiovasc. Trans. Res.

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Conduction system pacing (CSP) has the potential to achieve physiological-paced activation by pacing the ventricular conduction system. Before CSP is adopted in standard clinical practice, large, randomised, and multi-centre trials are required to investigate CSP safety and efficacy compared to standard biventricular pacing (BVP). Furthermore, there are unanswered questions about pacing thresholds required to achieve optimal pacing delivery while preventing device battery draining, and about which patient groups are more likely to benefit from CSP rather than BVP. In silico studies have been increasingly used to investigate mechanisms underlying changes in cardiac function in response to pathologies and treatment. In the context of CSP, they have been used to improve our understanding of conduction system capture to optimise CSP delivery and battery life, and noninvasively compare different pacing methods on different patient groups. In this review, we discuss the in silico studies published to date investigating different aspects of CSP delivery. Graphical Abstract

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His Bundle Pacing but not Left Bundle Pacing Corrects Septal Flash in Left Bundle Branch Block Patients

Cited by 4 publications

References 9 publications

Pacing interventions in non-responders to cardiac resynchronization therapy

Pacing interventions in non-responders to cardiac resynchronization therapy

Automated Framework for the Inclusion of a His–Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology

Computational Modelling Enabling In Silico Trials for Cardiac Physiologic Pacing

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