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Multisite pacing and myocardial scars: a computational study.

Mohammad Albatat1, Jacob Bergsland1, Hermenegild Arevalo2

  • 1Intervention Centre, Oslo University Hospital, Oslo, Norway.

Computer Methods in Biomechanics and Biomedical Engineering
|January 21, 2020
PubMed
Summary
This summary is machine-generated.

Multisite pacing (MSP) can improve cardiac resynchronization therapy (CRT) outcomes in heart failure patients with left ventricular (LV) scars. Optimal pacing sites, identified through computational modeling, are remote from scar tissue and the septum.

Keywords:
CRTComputational modellingcardiac electrophysiologymultisite pacing

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Area of Science:

  • Cardiology
  • Biomedical Engineering
  • Computational Biology

Background:

  • Cardiac resynchronization therapy (CRT) is effective for dyssynchronous heart failure, but 30% of patients lack response.
  • Suboptimal left ventricular (LV) activation, often due to myocardial scars, is a primary cause of CRT non-response.
  • The impact of multisite pacing (MSP) on CRT outcomes in the presence of LV myocardial scars remains incompletely understood.

Purpose of the Study:

  • To investigate the efficacy of multisite pacing (MSP) in a computational model of the left ventricle (LV) with myocardial scarring.
  • To evaluate the influence of scar location and size on the hemodynamic response to MSP.
  • To identify optimal pacing strategies for improving CRT outcomes in patients with LV scars.

Main Methods:

  • A computational model of the LV was developed, incorporating myocardial scars of varying locations and sizes.
  • Simulations were performed using multisite pacing (MSP) with stimulation from anterior, posterior, and lateral LV sites, alongside septal (right ventricular) pacing.
  • Hemodynamic outcomes were assessed by measuring the maximum rate of intraventricular pressure increase (dP/dtmax) compared to isolated right ventricular pacing.

Main Results:

  • The most effective pacing strategies involved combinations of sites remote from scar tissue and septal pacing.
  • The highest increase in dP/dtmax, irrespective of scar size, was achieved with MSP using a pacing site on the LV free wall opposite the scar and another site opposite the septum.
  • Computational modeling demonstrated that strategic electrode placement, considering scar location, can significantly alter acute hemodynamics.

Conclusions:

  • In silico modeling suggests that multisite pacing (MSP) strategies can be optimized based on the location and extent of myocardial scarring in the left ventricle (LV).
  • Pacing electrode placement guided by scar mapping may improve acute hemodynamic performance in patients undergoing cardiac resynchronization therapy (CRT).
  • Computational modeling holds potential for enhancing the personalization and optimization of CRT.