Related Experiment Video

Updated: Dec 16, 2025

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

Published on: December 11, 2017

10.8K

His-bundle and left bundle pacing with optimized atrioventricular delay achieve superior electrical synchrony over

Marina Strocchi1, Angela W C Lee1, Aurel Neic2

  • 1School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.

Heart Rhythm
|July 1, 2020
PubMed

Insights

His-bundle pacing (HBP) is superior to biventricular pacing for cardiac resynchronization therapy in heart failure patients. Optimizing atrioventricular delay during left bundle pacing (LBP) is crucial for comparable outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Simulation

Background:

  • His-bundle pacing (HBP) and left bundle pacing (LBP) are novel methods for cardiac resynchronization therapy (CRT) in heart failure with left bundle branch block (LBBB).
  • Direct comparisons between HBP, LBP, and traditional biventricular pacing (BiV-endo) are lacking.
  • Potential negative effects of LBP on right ventricular (RV) activation times (ATs) require quantification.

Purpose of the Study:

  • To compare ventricular activation changes induced by HBP, LBP, left ventricular (LV) septal pacing, BiV-endo, and biventricular epicardial (BiV-epi) pacing.
  • To quantify the impact of LBP on RV activation times.

Main Methods:

  • Computer simulations of ventricular activation in 24 four-chamber heart meshes with His-Purkinje networks and LBBB.
  • Simulated pacing strategies included BiV-epi, BiV-endo (lateral and septal LV lead placement), HBP, and LBP.

Main Results:

  • HBP significantly reduced LV ATs and interventricular dyssynchrony compared to BiV-endo and BiV-epi.
  • LBP improved LV ATs but did not reduce interventricular dyssynchrony compared to BiV-endo/BiV-epi.
  • RV latest AT was higher with LBP than HBP, but optimization of AV delay during LBP normalized RV ATs.

Conclusions:

  • HBP demonstrates superiority over BiV-epi and BiV-endo pacing in reducing LV ATs and dyssynchrony.
  • Optimizing AV delay during LBP is necessary to achieve outcomes comparable to HBP by mitigating increased RV ATs.
Abstract

Keywords:
Cardiac resynchronization therapyHeart failureHis-bundle pacingLeft bundle branch blockLeft bundle pacing

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