[home] [Personal Program] [Help]

---

Session: Poster session 2 (Odd numbers)
Session starts: Friday 27 January, 10:00
Presentation starts: 10:00

---

Roel Meiburg (Department of Biomedical Engineering, Cardiovascular Research Institute (CARIM), Maastricht University)
Jesse Rijks (Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University, )
Ahmed Beela (Department of Biomedical Engineering, Cardiovascular Research Institute (CARIM), Maastricht University, )
Justin Luermans (Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University, )
Luuk Heckman (Department of Physiology, Cardiovascular Research Institute (CARIM), Maastricht University, )
Tammo Delhaas (Department of Biomedical Engineering, Cardiovascular Research Institute (CARIM), Maastricht University, )
Frits Prinzen (Department of Physiology, Cardiovascular Research Institute (CARIM), Maastricht University, )
Kevin Vernooy (Department of Cardiology, Cardiovascular Research Institute (CARIM), Maastricht University, )
Joost Lumens (Department of Biomedical Engineering, Cardiovascular Research Institute (CARIM), Maastricht University, )

Abstract:
Cardiac resynchronisation therapy (CRT) has shown to reduce mortality in patients suffering from heart failure, but still leads to non-physiological electrical and mechanical activation of the heart. Recently, alternative pacing strategies such as left bundle branch pacing (LBBP) and LV septal pacing (LVSP) are being explored, as they are thought to be more physiological. Although much work has been done to explore the electrophysiological response to LBBP/LVSP, their effect on left and right ventricular mechanical and haemodynamic function is underappreciated. This is partially due to the fact that cardiac function is also highly dependent on the mechanical viability of the underlying tissue, which is difficult to measure clinically and often already compromised in heart failure patients. Computational modelling provides an opportunity to help understand and directly compare the effects of LBBP/LVSP and CRT without any confounding variables. Furthermore, the effect of each pacing strategy can be simulated for different heart failure phenotypes. To simulate the placement of a pacing device, electrical activation maps were generated on a realistic 3D geometry of the LV and RV using a graph-based formulation of the Eikonal model. The geometry was segmented and activation times for each segment were averaged, which were then used to inform the CircAdapt model of human cardiovascular mechanics and haemodynamics to calculate the effects of the different pacing strategies on cardiac pump function. This approach is computationally cheap compared to full 3D (Finite Element) simulations, whilst still providing results on a spatial resolution similar to data currently available in the clinical setting. Initial results show that selective LBBP mostly restores LV function at the cost of RV function loss, similar to a right bundle branch block pattern. Non-selective LBBP reduces RV load compared to sLBBP, but leads to earlier septal activation and increased intra-ventricular dyssynchrony. LVSP further reduces RV load and increases interventricular dyssynchrony, but still performs similarly to CRT. These findings hold when simulating different levels of mechanical viability and are consistent with clinical findings. Finally, this framework is easily expanded to simulate other cardiac dysfunctions, such as myocardial infarction.