{"doi":"10.1111/jce.15847","title":"Effect of scar and His–Purkinje and myocardium conduction on response to conduction system pacing","abstract":"INTRODUCTION: Conduction system pacing (CSP), in the form of His bundle pacing (HBP) or left bundle branch pacing (LBBP), is emerging as a valuable cardiac resynchronization therapy (CRT) delivery method. However, patient selection and therapy personalization for CSP delivery remain poorly characterized. We aim to compare pacing-induced electrical synchrony during CRT, HBP, LBBP, HBP with left ventricular (LV) epicardial lead (His-optimized CRT [HOT-CRT]), and LBBP with LV epicardial lead (LBBP-optimized CRT [LOT-CRT]) in patients with different conduction disease presentations using computational modeling. METHODS: We simulated ventricular activation on 24 four-chamber heart geometries, including His-Purkinje systems with proximal left bundle branch block (LBBB). We simulated septal scar, LV lateral wall scar, and mild and severe myocardium and LV His-Purkinje system conduction disease by decreasing the conduction velocity (CV) down to 70% and 35% of the healthy CV. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (90% of biventricular activation time [BIVAT-90]). RESULTS: Severe LV His-Purkinje conduction disease favored CRT (BIVAT-90: HBP 101.5 ± 7.8 ms vs. CRT 93.0 ± 8.9 ms, p < .05), with additional electrical synchrony induced by HOT-CRT (87.6 ± 6.7 ms, p < .05) and LOT-CRT (73.9 ± 7.6 ms, p < .05). Patients with slow myocardium CV benefit more from CSP compared to CRT (BIVAT-90: CRT 134.5 ± 24.1 ms; HBP 97.1 ± 9.9 ms, p < .01; LBBP: 101.5 ± 10.7 ms, p < .01). Septal but not lateral wall scar made CSP ineffective, while CRT was able to resynchronize the ventricles in the presence of septal scar (BIVAT-90: baseline 119.1 ± 10.8 ms vs. CRT 85.1 ± 14.9 ms, p < .01). CONCLUSION: Severe LV His-Purkinje conduction disease attenuates the benefits of CSP, with additional improvements achieved with HOT-CRT and LOT-CRT. Septal but not lateral wall scars make CSP ineffective.","journal":"Journal of Cardiovascular Electrophysiology","year":2023,"id":323864,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":35,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9664,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":572626,"name":"Karli Gillette","orcid":"0000-0002-0420-5375","position":1,"is_corresponding":false},{"id":913373,"name":"Aurel Neic","orcid":"0000-0002-5192-1307","position":2,"is_corresponding":false},{"id":713809,"name":"Mark K. Elliott","orcid":"0000-0003-2805-3043","position":3,"is_corresponding":false},{"id":891997,"name":"Nadeev Wijesuriya","orcid":"0000-0001-7893-0708","position":4,"is_corresponding":false},{"id":715273,"name":"Vishal Mehta","orcid":"0000-0001-6140-068X","position":5,"is_corresponding":false},{"id":353926,"name":"Edward J. Vigmond","orcid":"0000-0003-1388-3589","position":6,"is_corresponding":false},{"id":353925,"name":"Gernot Plank","orcid":"0000-0002-7380-6908","position":7,"is_corresponding":false},{"id":715275,"name":"Christopher A. Rinaldi","orcid":"0000-0002-3930-1957","position":8,"is_corresponding":false},{"id":328101,"name":"Steven Niederer","orcid":"0000-0002-4612-6982","position":9,"is_corresponding":false},{"id":638057,"name":"Marina Strocchi","orcid":"0000-0003-1312-251X","position":0,"is_corresponding":true}],"reference_count":27,"raw_metadata":null,"created_at":"2026-07-19T01:08:06.496579Z","pmid":"36738149","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}