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Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients

A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied....

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Autores principales: Strocchi, Marina, Gillette, Karli, Neic, Aurel, Elliott, Mark K., Wijesuriya, Nadeev, Mehta, Vishal, Vigmond, Edward J., Plank, Gernot, Rinaldi, Christopher A., Niederer, Steven A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532840/
https://www.ncbi.nlm.nih.gov/pubmed/36213223
http://dx.doi.org/10.3389/fphys.2022.1011566
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author Strocchi, Marina
Gillette, Karli
Neic, Aurel
Elliott, Mark K.
Wijesuriya, Nadeev
Mehta, Vishal
Vigmond, Edward J.
Plank, Gernot
Rinaldi, Christopher A.
Niederer, Steven A.
author_facet Strocchi, Marina
Gillette, Karli
Neic, Aurel
Elliott, Mark K.
Wijesuriya, Nadeev
Mehta, Vishal
Vigmond, Edward J.
Plank, Gernot
Rinaldi, Christopher A.
Niederer, Steven A.
author_sort Strocchi, Marina
collection PubMed
description A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied. We aim to compare pacing-induced electrical synchrony during conventional CRT, HBP, and LBP in RBBB patients with different conduction disturbances, and to investigate whether alternative ways of delivering LBP improve response to pacing. We simulated ventricular activation on twenty-four four-chamber heart geometries each including a His-Purkinje system with proximal right bundle branch block (RBBB). We simulated RBBB combined with left anterior and posterior fascicular blocks (LAFB and LPFB). Additionally, RBBB was simulated in the presence of slow conduction velocity (CV) in the myocardium, left ventricular (LV) or right ventricular (RV) His-Purkinje system, and whole His-Purkinje system. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (BIVAT-90). Compared to baseline, HBP significantly improved activation times for RBBB alone (BIVAT-90: 66.9 ± 5.5 ms vs. 42.6 ± 3.8 ms, p < 0.01), with LAFB (69.5 ± 5.0 ms vs. 58.1 ± 6.2 ms, p < 0.01), with LPFB (81.8 ± 6.6 ms vs. 62.9 ± 6.2 ms, p < 0.01), with slow myocardial CV (119.4 ± 11.4 ms vs. 97.2 ± 10.0 ms, p < 0.01) or slow CV in the whole His-Purkinje system (102.3 ± 7.0 ms vs. 75.5 ± 5.2 ms, p < 0.01). LBP was only effective in RBBB cases if combined with anodal capture of the RV septum myocardium (BIVAT-90: 66.9 ± 5.5 ms vs. 48.2 ± 5.2 ms, p < 0.01). CRT significantly reduced activation times in RBBB in the presence of severely slow RV His-Purkinje CV (95.1 ± 7.9 ms vs. 84.3 ± 9.3 ms, p < 0.01) and LPFB (81.8 ± 6.6 ms vs. CRT: 72.9 ± 8.6 ms, p < 0.01). Both CRT and HBP were ineffective with severely slow CV in the LV His-Purkinje system. HBP is effective in RBBB patients with otherwise healthy myocardium and Purkinje system, while CRT and LBP are ineffective. Response to LBP improves when LBP is combined with RV septum anodal capture. CRT is better than HBP only in patients with severely slow CV in the RV His-Purkinje system, while CV slowing of the whole His-Purkinje system and the myocardium favor HBP over CRT.
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spelling pubmed-95328402022-10-06 Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients Strocchi, Marina Gillette, Karli Neic, Aurel Elliott, Mark K. Wijesuriya, Nadeev Mehta, Vishal Vigmond, Edward J. Plank, Gernot Rinaldi, Christopher A. Niederer, Steven A. Front Physiol Physiology A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied. We aim to compare pacing-induced electrical synchrony during conventional CRT, HBP, and LBP in RBBB patients with different conduction disturbances, and to investigate whether alternative ways of delivering LBP improve response to pacing. We simulated ventricular activation on twenty-four four-chamber heart geometries each including a His-Purkinje system with proximal right bundle branch block (RBBB). We simulated RBBB combined with left anterior and posterior fascicular blocks (LAFB and LPFB). Additionally, RBBB was simulated in the presence of slow conduction velocity (CV) in the myocardium, left ventricular (LV) or right ventricular (RV) His-Purkinje system, and whole His-Purkinje system. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (BIVAT-90). Compared to baseline, HBP significantly improved activation times for RBBB alone (BIVAT-90: 66.9 ± 5.5 ms vs. 42.6 ± 3.8 ms, p < 0.01), with LAFB (69.5 ± 5.0 ms vs. 58.1 ± 6.2 ms, p < 0.01), with LPFB (81.8 ± 6.6 ms vs. 62.9 ± 6.2 ms, p < 0.01), with slow myocardial CV (119.4 ± 11.4 ms vs. 97.2 ± 10.0 ms, p < 0.01) or slow CV in the whole His-Purkinje system (102.3 ± 7.0 ms vs. 75.5 ± 5.2 ms, p < 0.01). LBP was only effective in RBBB cases if combined with anodal capture of the RV septum myocardium (BIVAT-90: 66.9 ± 5.5 ms vs. 48.2 ± 5.2 ms, p < 0.01). CRT significantly reduced activation times in RBBB in the presence of severely slow RV His-Purkinje CV (95.1 ± 7.9 ms vs. 84.3 ± 9.3 ms, p < 0.01) and LPFB (81.8 ± 6.6 ms vs. CRT: 72.9 ± 8.6 ms, p < 0.01). Both CRT and HBP were ineffective with severely slow CV in the LV His-Purkinje system. HBP is effective in RBBB patients with otherwise healthy myocardium and Purkinje system, while CRT and LBP are ineffective. Response to LBP improves when LBP is combined with RV septum anodal capture. CRT is better than HBP only in patients with severely slow CV in the RV His-Purkinje system, while CV slowing of the whole His-Purkinje system and the myocardium favor HBP over CRT. Frontiers Media S.A. 2022-09-21 /pmc/articles/PMC9532840/ /pubmed/36213223 http://dx.doi.org/10.3389/fphys.2022.1011566 Text en Copyright © 2022 Strocchi, Gillette, Neic, Elliott, Wijesuriya, Mehta, Vigmond, Plank, Rinaldi and Niederer. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Strocchi, Marina
Gillette, Karli
Neic, Aurel
Elliott, Mark K.
Wijesuriya, Nadeev
Mehta, Vishal
Vigmond, Edward J.
Plank, Gernot
Rinaldi, Christopher A.
Niederer, Steven A.
Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title_full Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title_fullStr Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title_full_unstemmed Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title_short Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
title_sort comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9532840/
https://www.ncbi.nlm.nih.gov/pubmed/36213223
http://dx.doi.org/10.3389/fphys.2022.1011566
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