Basic/Translational Science -> Computer Modeling/Simulation D-PO02 - Poster Session II (ID 47) Poster

D-PO02-035 - His Bundle Pacing Is Superior To Biventricular Pacing For Resynchronizing Ventricular Activation In Left Bundle Branch Block Patients (ID 169)


Background: Selective His bundle pacing (HBP) is a new pacing strategy for cardiac resynchronization therapy (CRT). Short-term, single center studies identified HBP as a promising alternative to biventricular (BiV) epicardial (epi) pacing. However, HBP has never been compared to both BiV endocardial (endo) and epi pacing.
Objective: To quantify the effects of HBP on electrical activation compared to BiV endo and epi pacing with computer simulations.
Methods: We computed ventricular activation on 24 four-chamber heart geometries inclusive of Purkinje networks with LBBB (Fig A). We simulated selective HBP by stimulating the His bundle below the block. We compared the reduction in QRS duration (QRSd) and LV 95% activation time (LV-AT 95) from baseline for selective HPB, BiV endo and BiV epi pacing.
Results: QRSd was significantly reduced for selective HBP (-31±9ms) compared to both BiV epi (-3±5ms, p<0.01) and endo pacing (-21±8ms, p<0.01) [Fig B]. LV-AT 95 was also significantly shorter with HBP compared to BiV epi pacing (HBP: -49±6ms vs BiV epi: -34±4ms, p < 0.01) [Fig C]. However there were no significant differences in the LV-AT 95 between HBP and BiV endo pacing (HBP: -49±6ms vs BiV endo: -47±5ms, p > 0.01).
Conclusion: LBBB patients benefit from better electrical resynchronization with HBP compared to optimal BiV endo and epi pacing, as HBP restores the native synchronous activation of ventricular tissue by recruiting the fast-conducting Purkinje system.