Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing

Marina Strocchi; Karli Gillette; Aurel Neic; Mark K. Elliott; Nadeev Wijesuriya; Vishal Mehta; Edward J. Vigmond; Gernot Plank; Christopher A. Rinaldi; Steven A. Niederer

doi:10.1111/jce.15847

Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing

Marina Strocchi^*, Karli Gillette, Aurel Neic, Mark K. Elliott, Nadeev Wijesuriya, Vishal Mehta, Edward J. Vigmond, Gernot Plank, Christopher A. Rinaldi, Steven A. Niederer

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

11 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	984-993
Number of pages	10
Journal	Journal of Cardiovascular Electrophysiology
Volume	34
Issue number	4
DOIs	https://doi.org/10.1111/jce.15847
Publication status	Published - Apr 2023

Keywords

cardiac resynchronization therapy
conduction system pacing
heart failure
His bundle pacing
left bundle branch block
left bundle pacing

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10.1111/jce.15847

Cite this

@article{63a8034d86b44234b216cd9907e96bed,

title = "Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing",

abstract = "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.",

keywords = "cardiac resynchronization therapy, conduction system pacing, heart failure, His bundle pacing, left bundle branch block, left bundle pacing",

author = "Marina Strocchi and Karli Gillette and Aurel Neic and Elliott, {Mark K.} and Nadeev Wijesuriya and Vishal Mehta and Vigmond, {Edward J.} and Gernot Plank and Rinaldi, {Christopher A.} and Niederer, {Steven A.}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors. Journal of Cardiovascular Electrophysiology published by Wiley Periodicals LLC.",

year = "2023",

month = apr,

doi = "10.1111/jce.15847",

language = "English",

volume = "34",

pages = "984--993",

journal = "Journal of Cardiovascular Electrophysiology",

issn = "1045-3873",

publisher = "Wiley-Blackwell",

number = "4",

}

TY - JOUR

T1 - Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing

AU - Strocchi, Marina

AU - Gillette, Karli

AU - Neic, Aurel

AU - Elliott, Mark K.

AU - Wijesuriya, Nadeev

AU - Mehta, Vishal

AU - Vigmond, Edward J.

AU - Plank, Gernot

AU - Rinaldi, Christopher A.

AU - Niederer, Steven A.

PY - 2023/4

Y1 - 2023/4

N2 - 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.

AB - 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.

KW - cardiac resynchronization therapy

KW - conduction system pacing

KW - heart failure

KW - His bundle pacing

KW - left bundle branch block

KW - left bundle pacing

UR - http://www.scopus.com/inward/record.url?scp=85148288448&partnerID=8YFLogxK

U2 - 10.1111/jce.15847

DO - 10.1111/jce.15847

M3 - Article

C2 - 36738149

AN - SCOPUS:85148288448

SN - 1045-3873

VL - 34

SP - 984

EP - 993

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

IS - 4

ER -

Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing

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