{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:55:48Z","timestamp":1791309348766,"version":"4.3.1"},"reference-count":64,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["#465189069"],"award-info":[{"award-number":["#465189069"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["#507828355"],"award-info":[{"award-number":["#507828355"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"abstract":"<jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      Left bundle branch block (LBBB) describes a disruption or delay in electrical conduction through the left bundle branch of the His\u2010Purkinje system (HPS). While new\u2010onset LBBB commonly emerges in individuals with a history of hypertension, cardiomegaly or coronary artery disease, it can also occur in the absence of other cardiovascular abnormalities. Whether LBBB is a cause or a consequence of heart failure remains unclear. In this work, we used six different electromechanical\n                      <jats:italic>in silico<\/jats:italic>\n                      heart models with an integrated HPS to simulate both a healthy control and a pure LBBB case for each geometry, affecting only the HPS in the absence of other cardiovascular pathologies. We compared electrophysiological, mechanical and haemodynamic metrics between both cases. Despite exhibiting a severe delay of up to 87\u00a0ms in left ventricular activation, all six virtual patients showed almost no acute change in ejection fraction (EF) due to LBBB. However, an absolute increase in septal flash of 1.4\u00a0mm to 2.7\u00a0mm indicated mechanical dyssynchrony. Furthermore, we observed a relative strain increase of 12.3\u201330% in the left ventricular free wall across all models. The load imbalance marked by the strain increase could drive LBBB\u2010induced remodelling, leading to a major reduction in EF over time. Regardless of variations in heart geometry, this study shows that electrical dyssynchrony immediately affects mechanics more than haemodynamics. In line with clinical data, our findings suggest that patients with LBBB might benefit from an earlier application of cardiac resynchronization therapy to prevent strain\u2010induced remodelling and preserve cardiac output.\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/tjp70867-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>Left bundle branch block (LBBB) describes an impairment of electrical conduction in the left bundle branch of the His\u2010Purkinje system, causing a delay in left ventricular activation.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>While LBBB has been discussed as a risk factor for the progression of heart failure, the exact relationship of acute and chronic effects of LBBB in heart failure is not fully understood.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>\n                            In this study, we simulated both a healthy and a pure and acute LBBB scenario in six different electromechanical\n                            <jats:italic>in silico<\/jats:italic>\n                            heart models.\n                          <\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Pure LBBB induced mechanical dyssynchrony, increasing septal flash and left ventricular free wall strain, while the ejection fraction remained virtually unchanged.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>The strain\u2010induced load imbalance may cause long\u2010term remodelling, reducing ejection fraction over time.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>In line with clinical data, our results suggest an early application of cardiac resynchronization therapy in patients with LBBB to prevent remodelling and sustain cardiac output.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  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