ArticleHeart rhythm2020
Left ventricular endocardial pacing is less arrhythmogenic than conventional epicardial pacing when pacing in proximity to scar.
Article in Heart rhythm, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
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Who cites it
12 citing papers in PubMed, 24 citations in OpenAlex.
- Accounting for uncertainty in computational models of ventricular tachycardia improves ablation guidance.Nature cardiovascular research · 2026Article
- Reconstructing ventricular activation sequences from epicardial data: Insights from Geodesic Back-Propagation optimization in porcine models.Computers in biology and medicine · 2025Article
- Recent Advances in Cardiac Resynchronization Therapy: Current Treatment and Future Direction.Journal of clinical medicine · 2025Review
- Personalized computational electro-mechanics simulations to optimize cardiac resynchronization therapy.Biomechanics and modeling in mechanobiology · 2024Article
- Optogenetic Modulation of Arrhythmia Triggers: Proof-of-Concept from Computational Modeling.Cellular and molecular bioengineering · 2023Article
- 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
- Effect of scar and pacing location on repolarization in a porcine myocardial infarction model.Heart rhythm O2 · 2022Article
- Determining anatomical and electrophysiological detail requirements for computational ventricular models of porcine myocardial infarction.Computers in biology and medicine · 2022Article
- Endocardial left ventricular pacing.Herz · 2021Review
- Leadless Left Ventricular Endocardial Pacing and Left Bundle Branch Area Pacing for Cardiac Resynchronisation Therapy.Arrhythmia & electrophysiology review · 2021Review
- Translational applications of computational modelling for patients with cardiac arrhythmias.Heart (British Cardiac Society) · 2020Review
- Dispersion of repolarization increases with cardiac resynchronization therapy and is associated with left ventricular reverse remodeling.Journal of electrocardiologyArticle
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Authors and funding
13 authors at 3 institutions in 2 countries.
Funding
Abstract
backgroundEpicardial pacing increases risk of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) when pacing in proximity to scar. Endocardial pacing may be less arrhythmogenic as it preserves the physiological sequences of activation and repolarization.
objectiveThe purpose of this study was to determine the relative arrhythmogenic risk of endocardial compared to epicardial pacing, and the role of the transmural gradient of action potential duration (APD) and pacing location relative to scar on arrhythmogenic risk during endocardial pacing.
methodsComputational models of ICM patients (n = 24) were used to simulate left ventricular (LV) epicardial and endocardial pacing 0.2-3.5 cm from a scar. Mechanisms were investigated in idealized models of the ventricular wall and scar. Simulations were run with/without a 20-ms transmural APD gradient in the physiological direction and with the gradient inverted. Dispersion of repolarization was computed as a surrogate of VT risk.
resultsPatient-specific models with a physiological APD gradient predict that endocardial pacing decreases VT risk (34%; P <.05) compared to epicardial pacing when pacing in proximity to scar (0.2 cm). Endocardial pacing location does not significantly affect VT risk, but epicardial pacing at 0.2 cm compared to 3.5 cm from scar increases it (P <.05). Inverting the transmural APD gradient reverses this trend. Idealized models predict that propagation in the direction opposite to APD gradient decreases VT risk.
conclusionEndocardial pacing is less arrhythmogenic than epicardial pacing when pacing proximal to scar and is less susceptible to pacing location relative to scar. The physiological repolarization sequence during endocardial pacing mechanistically explains reduced VT risk compared to epicardial pacing.
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