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Abstract: Electrode Model and Simulation of His Bundle Pacing for Cardiac Resynchronization Therapy

  • Background: A disturbed synchronization of the ventricular contraction can cause a highly developed systolic heart failure in affected patients, which can often be explained by a diseased left bundle branch block (LBBB). If medication remains unresponsive, the concerned patients will be treated with a cardiac resynchronization therapy (CRT) system. The aim of this study was to integrate His bundleBackground: A disturbed synchronization of the ventricular contraction can cause a highly developed systolic heart failure in affected patients, which can often be explained by a diseased left bundle branch block (LBBB). If medication remains unresponsive, the concerned patients will be treated with a cardiac resynchronization therapy (CRT) system. The aim of this study was to integrate His bundle pacing into the Offenburg heart rhythm model in order to visualize the electrical pacing field generated by His bundle pacing. Methods: Modelling and electrical field simulation activities were performed with the software CST (Computer Simulation Technology) from Dessault Systèms. CRT with biventricular pacing is to be achieved by an apical right ventricular electrode and an additional left ventricular electrode, which is floated into the coronary vein sinus. This conventional type of biventricular pacing leads to a reduction of the left ventricular ejection fraction. Furthermore, the non-responder rate of the CRT therapy is about one third of the CRT patients. Results: His bundle pacing represents a physiological alternative to conventional cardiac pacing and cardiac resynchronization. An electrode implanted in the His bundle emits a stronger electrical pacing field than the electrical pacing field of conventional cardiac pacemakers. The pacing of the His bundle was performed by the Medtronic Select Secure 3830 electrode with pacing voltage amplitudes of 3 V, 2 V and 1.5 V in combination with a pacing pulse duration of 1 ms. Conclusions: Compared to conventional cardiac pacemaker pacing, His bundle pacing is capable of bridging LBBB conduction disorders in the left ventricle. The His bundle pacing electrical field is able to spread via the physiological pathway in the right and left ventricles for CRT with a narrow QRS-complex in the surface ECG.show moreshow less

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Author:Domenic Pascual, Matthias HeinkeGND, Reinhard EchleGND, Johannes Hörth
Creating Corporation:Joint Journal of the German Society for Biomedical Engineering in VDE and the Austrian and Swiss Societies for Biomedical Engineering and the German Society of Biomaterials
Publisher:Walter de Gruyter
Place of publication:Berlin, Boston
Year of Publication:2020
Pagenumber:1
Language:English
Tag:3D-Modelling; Cardiac Resynchronization Therapy; Heart Rhythm Simulation; His-Bundle Pacing; Physiological Pacing
DDC classes:600 Technik, Medizin, angewandte Wissenschaften
Parent Title (English):Biomedical Engineering / Biomedizinische Technik
Volume:65
Issue:s1
ISSN:1862-278X (Online)
ISSN:0013-5585 (Print)
First Page:258
Document Type:Article (reviewed)
Institutes:Bibliografie
Acces Right:Zugriffsbeschränkt
Release Date:2021/01/12
Licence (German):License LogoEs gilt das UrhG
Note:
Konferenzbeitrag: BMT 2020 - 54th Conference of the German Society for Biomedical Engineering (DGBMT within VDE), Leipzig, September 29-October 1, Poster Session: Modelbased Personalised Medicine
URL:https://www.degruyter.com/view/journals/bmte/65/s1/article-p255.xml
DOI:https://doi.org/10.1515/bmt-2020-6044