Basic/Translational Science -> Computer Modeling/Simulation D-PO03 - Poster Session III (ID 48) Poster

D-PO03-016 - Left Bundle Pacing Is Comparable To His Bundle Pacing In Resolving Intra-ventricular Dyssynchrony (ID 271)


Background: Selective (S-) and non-selective (NS-) His bundle pacing (HBP) are novel pacing strategies for CRT. Although HBP is associated with excellent clinical outcomes, it is technically challenging. S- and NS- left bundle pacing (LBP) are a valuable and more feasible alternative to HBP. However, comparative studies of LBP vs HBP have not been done.
Objective: To investigate the effect of S- and NS- LBP vs HBP on ventricular activation using computer models.
Methods: We computed ventricular activation on 24 heart failure heart geometries, inclusive of Purkinje networks with LBBB. We simulated S-HBP by pacing the His bundle below the block [Fig A, green circle]. S-LBP was simulated by stimulating the center of the left bundle [Fig A, orange diamond]. We simulated NS- pacing by extending these stimuli to the surrounding myocardium. We compared S-LBP, NS-LBP, S-HBP and NS-HBP by measuring the reduction in QRS duration (QRSd) and LV 95% activation time (LV-AT 95) from LBBB baseline activation.
Results: Comparable results for QRSd reduction (p>0.1) were achieved for HBP vs LBP for both NS- (-26±10ms vs -25±9ms, respectively) and S- (-31±9ms vs -30±9ms, respectively). The QRSd reduction was improved for S- vs NS- for both HBP and LBP (p<0.05) [Fig B]. Reduction in LV-AT 95 for HBP vs LBP (p>0.1) were also found to be comparable for NS- (-59±6ms vs -60±6ms, respectively) and S- (-49±6ms vs -52±6ms, respectively). NS- had an improved reduction in LV-AT 95 compared to S- for both LBP and HBP (p<0.05) [Fig C].
Conclusion: S-LBP and NS-LBP are comparable to S-HBP and NS-HBP in resynchronizing ventricular activation. LBP thus constitutes an equivalent, less technically challenging alternative to HBP.