{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:11:24Z","timestamp":1785247884610,"version":"3.55.0"},"reference-count":28,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T00:00:00Z","timestamp":1663718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","award":["WT 203148\/Z\/16\/Z"],"award-info":[{"award-number":["WT 203148\/Z\/16\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","award":["WT 203148\/Z\/16\/Z EP\/P01268X\/1"],"award-info":[{"award-number":["WT 203148\/Z\/16\/Z EP\/P01268X\/1"]}],"id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01-HL152256"],"award-info":[{"award-number":["R01-HL152256"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000781","name":"European Research Council","doi-asserted-by":"publisher","award":["453 (864055)"],"award-info":[{"award-number":["453 (864055)"]}],"id":[{"id":"10.13039\/501100000781","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","award":["RG\/20\/4\/34803"],"award-info":[{"award-number":["RG\/20\/4\/34803"]}],"id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Physiol."],"abstract":"<jats:p>A significant number of right bundle branch block (RBBB) patients receive cardiac resynchronization therapy (CRT), despite lack of evidence for benefit in this patient group. His bundle (HBP) and left bundle pacing (LBP) are novel CRT delivery methods, but their effect on RBBB remains understudied. We aim to compare pacing-induced electrical synchrony during conventional CRT, HBP, and LBP in RBBB patients with different conduction disturbances, and to investigate whether alternative ways of delivering LBP improve response to pacing. We simulated ventricular activation on twenty-four four-chamber heart geometries each including a His-Purkinje system with proximal right bundle branch block (RBBB). We simulated RBBB combined with left anterior and posterior fascicular blocks (LAFB and LPFB). Additionally, RBBB was simulated in the presence of slow conduction velocity (CV) in the myocardium, left ventricular (LV) or right ventricular (RV) His-Purkinje system, and whole His-Purkinje system. Electrical synchrony was measured by the shortest interval to activate 90% of the ventricles (BIVAT-90). Compared to baseline, HBP significantly improved activation times for RBBB alone (BIVAT-90: 66.9 \u00b1 5.5\u00a0ms vs. 42.6 \u00b1 3.8\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01), with LAFB (69.5 \u00b1 5.0\u00a0ms vs. 58.1 \u00b1 6.2\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01), with LPFB (81.8 \u00b1 6.6\u00a0ms vs. 62.9 \u00b1 6.2\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01), with slow myocardial CV (119.4 \u00b1 11.4\u00a0ms vs. 97.2 \u00b1 10.0\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01) or slow CV in the whole His-Purkinje system (102.3 \u00b1 7.0\u00a0ms vs. 75.5 \u00b1 5.2\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01). LBP was only effective in RBBB cases if combined with anodal capture of the RV septum myocardium (BIVAT-90: 66.9 \u00b1 5.5\u00a0ms vs. 48.2 \u00b1 5.2\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01). CRT significantly reduced activation times in RBBB in the presence of severely slow RV His-Purkinje CV (95.1 \u00b1 7.9\u00a0ms vs. 84.3 \u00b1 9.3\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01) and LPFB (81.8 \u00b1 6.6\u00a0ms vs. CRT: 72.9 \u00b1 8.6\u00a0ms, <jats:italic>p<\/jats:italic> &amp;lt; 0.01). Both CRT and HBP were ineffective with severely slow CV in the LV His-Purkinje system. HBP is effective in RBBB patients with otherwise healthy myocardium and Purkinje system, while CRT and LBP are ineffective. Response to LBP improves when LBP is combined with RV septum anodal capture. CRT is better than HBP only in patients with severely slow CV in the RV His-Purkinje system, while CV slowing of the whole His-Purkinje system and the myocardium favor HBP over CRT.<\/jats:p>","DOI":"10.3389\/fphys.2022.1011566","type":"journal-article","created":{"date-parts":[[2022,9,21]],"date-time":"2022-09-21T06:06:51Z","timestamp":1663740411000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":14,"title":["Comparison between conduction system pacing and cardiac resynchronization therapy in right bundle branch block patients"],"prefix":"10.3389","volume":"13","author":[{"given":"Marina","family":"Strocchi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karli","family":"Gillette","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurel","family":"Neic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark K.","family":"Elliott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadeev","family":"Wijesuriya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vishal","family":"Mehta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J.","family":"Vigmond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gernot","family":"Plank","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher A.","family":"Rinaldi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven A.","family":"Niederer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,9,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1161\/01.RES.0000144125.61927.1c","article-title":"Mechanisms underlying conduction slowing and arrhythmogenesis in nonischemic dilated cardiomyopathy","volume":"95","author":"Akar","year":"2004","journal-title":"Circ. 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