title: Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy.
abstract: Cardiac anatomy and function adapt in response to chronic cardiac resynchronization therapy (CRT). The effects of these changes on the optimal left ventricle (LV) lead location and timing delay settings have yet to be fully explored.
  
  
  
  To predict the effects of chronic CRT on the optimal LV lead location and device timing settings over time.
  
  
  
  Biophysical computational cardiac models were generated for 3 patients, immediately post-implant (ACUTE) and after at least 6 months of CRT (CHRONIC). Optimal LV pacing area and device settings were predicted by pacing the ACUTE and CHRONIC models across the LV epicardium (49 sites each) with a range of 9 pacing settings and simulating the acute hemodynamic response (AHR) of the heart.
  
  
  
  There were statistically significant differences between the distribution of the AHR in the ACUTE and CHRONIC models (P < 0.0005 in all cases). The site delivering the maximal AHR shifted location between the ACUTE and CHRONIC models but provided a negligible improvement (<2%). The majority of the acute optimal LV pacing regions (76-100%) and device settings (76-91%) remained optimal chronically.
  
  
  
  Optimization of the LV pacing location and device settings were important at the time of implant, with a reduced benefit over time, where the majority of the acute optimal LV pacing region and device settings remained optimal with chronic CRT.
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Angela W C
authors.initials: AW
authors.lastname: Lee
authors.affiliation: Institute of Biophysics, Medical University of Graz, Graz, Austria.
authors.forename: Andrew
authors.initials: A
authors.lastname: Crozier
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Eoin R
authors.initials: ER
authors.lastname: Hyde
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Pablo
authors.initials: P
authors.lastname: Lamata
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Truong
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Manav
authors.initials: M
authors.lastname: Sohal
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Jackson
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Behar
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Claridge
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Anoop
authors.initials: A
authors.lastname: Shetty
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Eva
authors.initials: E
authors.lastname: Sammut
authors.affiliation: Institute of Biophysics, Medical University of Graz, Graz, Austria.
authors.forename: Gernot
authors.initials: G
authors.lastname: Plank
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.|Cardiovascular Department, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Christopher Aldo
authors.initials: CA
authors.lastname: Rinaldi
authors.affiliation: Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Niederer
mesh_terms: D000200:Action Potentials; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D056149:Epicardial Mapping; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D066230:Patient-Specific Modeling; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
keywords: atrioventricular delay; cardiac resynchronization therapy; computer modeling/simulations; interventricular delay; left bundle branch block; left ventricular lead placement