In Silico Evaluation of New Approaches in Cardiac Resynchronization Therapy

Cardiac resynchronization therapy (CRT) is a widely used technique in the clinical setting to solve desynchronization problems in ventricular contraction. Among the different CRT approaches, the most widespread is biventricular pacing (BiVP), however, other newer approaches are beginning to be used, such as His optimized CRT (HOT-CRT) or left bundle branch area pacing (LBBAP). In silico cardiac models allow assessing the effectiveness of different approaches of CRT in a noninvasive way, becoming a powerful tool to guide clinicians. Thus, the aim of this study was to evaluate in silico the effectiveness of HOT-CRT and LBBAP. To do so, a biventricular model was used in which different pathologies were modelled and both CRT approaches (HOT-CRT and LBBAP) were analyzed. Multiple parameters have been considered when evaluating the effectiveness of each therapy, such as QRS duration (QRSd), time until 90% of ventricular activation (t90) or the time until 90% of QRS area is reached (a90). Results showed that both therapies were found to be effective and superior to BiVP, significantly reducing QRSd, a90 and t90 values with respect to the pathological initial values.