ArticleHeart rhythm2019
Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.
Article in Heart rhythm, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers, 1 of them a synthesis that pooled it.
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Who cites it
33 citing papers in PubMed, 1 synthesis or guideline pooled it, 61 citations in OpenAlex.
- Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2023Pooled it
- Efficacy of leadless left ventricular endocardial stimulation for non-responders to cardiac resynchronization therapy.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Observational
- Accounting for uncertainty in computational models of ventricular tachycardia improves ablation guidance.Nature cardiovascular research · 2026Article
- Prediction of arrhythmogenesis in non-ischemic cardiac resynchronization therapy patients.APL bioengineering · 2026Article
- Accelerated Intrinsic Beating Rate in Heterogeneously Coupled Human Pluripotent Stem Cell-Derived Cardiomyocytes Can Underlie Focal Ventricular Tachycardia in Regenerative Therapy.Journal of precision medicine (Amsterdam, Netherlands) · 2026Article
- Midnight punctual tachycardia.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2025Article
- Agreement on site of latest electrical activation between right ventricular pacing and intrinsic conduction as target for left ventricular lead position in cardiac resynchronization therapy.Heart rhythm O2 · 2025Article
- Comparing the effects of left bundle branch pacing and leadless right ventricular pacing on intraventricular and interventricular dyssynchrony usingFrontiers in physiology · 2025Article
- From bits to bedside: entering the age of digital twins in cardiac electrophysiology.Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Review
- Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy.Biomechanics and modeling in mechanobiology · 2024Article
- Article
- Optogenetic Modulation of Arrhythmia Triggers: Proof-of-Concept from Computational Modeling.Cellular and molecular bioengineering · 2023Article
- Effect of scar and His-Purkinje and myocardium conduction on response to conduction system pacing.Journal of cardiovascular electrophysiology · 2023Article
- Interindividual Age-Independent Differences in Human CX43 Impact Ventricular Arrhythmic Risk.Research (Washington, D.C.) · 2023Article
- Pacing interventions in non-responders to cardiac resynchronization therapy.Frontiers in physiology · 2023Review
- Leadless Pacing: Therapy, Challenges and Novelties.Arrhythmia & electrophysiology review · 2023Review
- The role of guidance in delivering cardiac resynchronization therapy: A systematic review and network meta-analysis.Heart rhythm O2 · 2022Article
- Credibility assessment of patient-specific computational modeling using patient-specific cardiac modeling as an exemplar.PLoS computational biology · 2022Article
- Computational electrophysiology of the coronary sinus branches based on electro-anatomical mapping for the prediction of the latest activated region.Medical & biological engineering & computing · 2022Article
- Modelling the interaction between stem cells derived cardiomyocytes patches and host myocardium to aid non-arrhythmic engineered heart tissue design.PLoS computational biology · 2022Article
Corrections and comments
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Authors and funding
12 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundCardiac resynchronization therapy (CRT) increases the risk of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) when the left ventricular (LV) epicardial lead is implanted in proximity to scar.
objectiveThe purpose of this study was to determine the mechanisms underpinning this risk by investigating the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT.
methodsImaging data from ICM patients (n = 24) undergoing CRT were used to create patient-specific LV anatomic computational models including scar morphology. Simulations of LV epicardial pacing at 0.2-4.5 cm from the scar were performed using EP models of chronic infarct and heart failure (HF). Dispersion of repolarization and the vulnerable window were computed as surrogates for VT risk.
resultsSimulations predict that pacing in proximity to scar (0.2 cm) compared to more distant pacing to a scar (4.5 cm) significantly (P <.01) increased dispersion of repolarization in the vicinity of the scar and widened (P <.01) the vulnerable window, increasing the likelihood of unidirectional block. Moreover, slow conduction during HF further increased dispersion (∼194%). Analysis of variance and post hoc tests show significantly (P <.01) reduced repolarization dispersion when pacing ≥3.5 cm from the scar compared to pacing at 0.2 cm.
conclusionIncreased dispersion of repolarization in the vicinity of the scar and widening of the vulnerable window when pacing in proximity to scar provides a mechanistic explanation for VT induction in ICM-CRT with lead placement proximal to scar. Pacing 3.5 cm or more from scar may avoid increasing VT risk in ICM-CRT patients.
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Registered trials
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