Comparison of His-Purkinje and Biventricular pacing in patient-specific computer models

Biventricular pacing (BiV) is a conventional form of cardiac resynchronization therapy (CRT) setting. Unfortunately, about 30% of patients undergoing CRT do not show clinical improvements. Direct His-Purkinje system stimulation (HPS) is a promising method to restore the physiological sequence of ventricular activation and synchronize contraction. In this study, we evaluate the effects of HPS on several indices of ventricular activation and electrical dyssynchrony in 27 patientspecific computer models of ventricles utilizing the CT imaging and ECG data from the patients. We compared simulation results of HPS pacing with standard BiV pacing using CT data on the location of ventricular leads (BiV CRT). Moreover, using personalized ventricular models we predicted an optimal position of LV lead in terms of minimization of QRS complex durations (QRSd) and compared outputs of this BiVopt model with other modes of ventricular pacing. We showed that the majority of indices demonstrated that HPS is superior to both BiV pacing.