His Bundle Pacing but not Left Bundle Pacing Corrects Septal Flash in Left Bundle Branch Block Patients

Abstract

His bundle pacing (HBP) and left bundle pacing (LBP) are novel delivery methods for cardiac resynchronisation therapy (CRT) for left bundle branch block (LBBB) patients. Septal flash (SF), an abnormal pre-ejection motion of the septum towards the left ventricle (LV) arising from dyssynchronous activation, has been shown in the past to be a robust and independent predictor for CRT response. Although small-cohort studies showed the feasibility and efficacy of HBP and LBP, the effects of HBP and LBP on septal motion have yet to be investigated. In this study, we used our four-chamber heart electro-mechanics simulation framework to determine whether HBP and LBP can correct for SF. We performed simulations in four four-chamber heart models. In synchronous and LBBB activation, simulated mean lateral septal movement from the right ventricle (RV) into the LV was -0.4±0.5mm and - 3.7±0.9mm (p<0.05), respectively. HBP reduced septal motion to -0.4±0.5mm (p=0.5 when compared to synchronous activation). In LBP, septal motion was reversed to 0.9±0.5mm and significantly different from synchronous activation (p<0.05). HBP was better able to recover septal function over LBP in patients with complete atrioventricular block.