Heart rhythm O2 · 2026
Computational analysis of intracardiac collision risk and optimal site for right ventricular leadless left bundle branch area pacing: A simulation study.
СтатьяНазвание и аннотация: Перевод в очереди
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Lee Angela W C, Strocchi Marina, Liew Alphonsus, Howell Sandra, De Vere Felicity, Wijesuriya Nadeev, Rajani Ronak, Rinaldi Christopher Aldo, Niederer Steven
Аннотация
BACKGROUND: Conduction system pacing with leadless left bundle branch area pacing (LBBAP) is a promising application of leadless pacemakers (L-PMs). However, the mechanical impact of the L-PM on intracardiac structures may worsen tricuspid regurgitation and induce ventricular arrhythmia. The optimal site of leadless conduction system pacing also remains unclear.
OBJECTIVE: This study aimed to quantify device- and site-specific collision risks and identify the optimal site for leadless LBBAP using computational modeling.
METHODS: We conducted a modeling study assessing collision risks of contemporary (Micra TPS, Aveir AR, and Aveir VR) and future L-PM devices and exploring the optimal site for leadless LBBAP using cardiac computed tomography models from 10 patients with heart failure. Virtual L-PM implantation on the right ventricular (RV) septal wall was performed, and models of the RV free wall, papillary muscles, moderator band, and tricuspid valve structures enabled assessment of device-structure interactions. Computer simulations examined collision risk across devices of varying dimensions throughout the cardiac cycle.
RESULTS: Collision risk increased with device length and volume, primarily driven by RV wall interactions. Apical pacing sites carried a 73.6%-75.2% collision risk, and overall wall collisions increased by 3%-8% per 5 mm device length. Tricuspid valve and papillary muscle collisions depended on implant region, with the highest risks of collision in basal-inferoseptal (>70%) and mid-inferoseptal regions (>40%), respectively. Leadless LBBAP via the left anterior fascicle had the lowest collision rates.
CONCLUSION: These findings support patient-specific device selection and careful septal targeting of leadless LBBAP to minimize complications, optimize physiological activation, and guide future L-PM designs.
OBJECTIVE: This study aimed to quantify device- and site-specific collision risks and identify the optimal site for leadless LBBAP using computational modeling.
METHODS: We conducted a modeling study assessing collision risks of contemporary (Micra TPS, Aveir AR, and Aveir VR) and future L-PM devices and exploring the optimal site for leadless LBBAP using cardiac computed tomography models from 10 patients with heart failure. Virtual L-PM implantation on the right ventricular (RV) septal wall was performed, and models of the RV free wall, papillary muscles, moderator band, and tricuspid valve structures enabled assessment of device-structure interactions. Computer simulations examined collision risk across devices of varying dimensions throughout the cardiac cycle.
RESULTS: Collision risk increased with device length and volume, primarily driven by RV wall interactions. Apical pacing sites carried a 73.6%-75.2% collision risk, and overall wall collisions increased by 3%-8% per 5 mm device length. Tricuspid valve and papillary muscle collisions depended on implant region, with the highest risks of collision in basal-inferoseptal (>70%) and mid-inferoseptal regions (>40%), respectively. Leadless LBBAP via the left anterior fascicle had the lowest collision rates.
CONCLUSION: These findings support patient-specific device selection and careful septal targeting of leadless LBBAP to minimize complications, optimize physiological activation, and guide future L-PM designs.