His bundle pacing (HBP) and left bundle pacing (LBP) are emerging as novel delivery methods for cardiac resynchronisation therapy (CRT) in heart failure patients with left bundle branch block (LBBB). HBP and LBP have never been compared to biventricular endocardial (BiV-endo) pacing. Furthermore, there are indications of negative effects of LBP on right ventricular (RV) activation times (ATs), but these effects have not been quantified.
The aim of this study is to compare changes in ventricular activation induced by HBP, LBP, LV septal pacing, BiV-endo and BiV-epi pacing using computer simulations.
We simulated ventricular activation on twenty-four four-chamber heart meshes inclusive of His-Purkinje network in presence of LBBB. We simulated BiV-epi pacing, BiV-endo pacing with left ventricular (LV) lead at the lateral wall, BiV-endo pacing with LV lead at the LV septum, HBP and LBP.
HBP was superior to BiV-endo and BiV-epi in terms of reduction in LV ATs and inter-ventricular dyssynchrony (p<0.05). LBP reduced LV ATs but not inter-ventricular dyssynchrony compared to BiV-epi and BiV-endo pacing. RV latest AT (LAT) was higher with LBP than with HBP (141.3±10.0ms vs 111.8±10.4ms). Optimising AV delay during LBP reduced RV LAT (104.7±8.7ms) and led to comparable response to HBP. In case of complete AV block, BiV-endo septal pacing was equivalent to LBP.
HBP is superior to BiV-epi and BiV-endo. To achieve comparable response to HBP, AV delay optimisation during LBP is required in order to reduce RV ATs.

Copyright © 2020. Published by Elsevier Inc.