{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T12:13:11Z","timestamp":1785413591557,"version":"3.56.0"},"reference-count":75,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["R01 HL166508"],"award-info":[{"award-number":["R01 HL166508"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"award":["R01 HL166508"],"award-info":[{"award-number":["R01 HL166508"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006370","name":"Small Business Innovation Research","doi-asserted-by":"crossref","award":["R43 HL174177"],"award-info":[{"award-number":["R43 HL174177"]}],"id":[{"id":"10.13039\/100006370","id-type":"DOI","asserted-by":"crossref"}]},{"award":["R43 HL174177"],"award-info":[{"award-number":["R43 HL174177"]}],"id":[{"id":"https:\/\/ror.org\/038nwvj35","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Cardiac and hemodynamic conditions such as myocardial infarct, cardiomyopathy, hypertension, and aortic valve disease can impair conduction within the Purkinje fiber network and compromise left ventricular (LV) pump function. We developed a computational framework that couples electrical propagation in a structurally organized Purkinje fiber network with LV electromechanics to analyze the impact of conduction abnormalities on cardiac performance. A baseline simulation reproduced physiological activation patterns and pump indices consistent with healthy human data. Conduction block was then introduced at different locations within the Purkinje fiber network. LV pump function was strongly dependent on block location: left bundle branch block (LBBB) produced the largest reduction in ejection fraction (EF) (59% to 46%) and peak pressure (119 to 97 mmHg), whereas left anterior fascicle block caused smaller functional changes. Across simulations, myocardial activation delay and systolic dyssynchrony index (SDI) exhibited a nonlinear relationship with EF and myocardial strain. A threshold behavior was identified at a simulated LV activation duration of approximately 240 ms and an SDI of 8.4%, beyond which EF and strain decreased by about 5% relative to baseline. These findings provide a mechanistic framework to investigate how Purkinje fiber network conduction abnormalities influence LV pump dysfunction.<\/jats:p>","DOI":"10.3390\/bioengineering13040464","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T14:02:33Z","timestamp":1776261753000},"page":"464","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Purkinje Fiber Conduction Block on Cardiac Pump Function: Computational Modeling Study"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0681-596X","authenticated-orcid":false,"given":"Sandra P.","family":"Hager","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vahid","family":"Ziaei-Rad","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7032-0777","authenticated-orcid":false,"given":"Jenny S.","family":"Choy","sequence":"additional","affiliation":[{"name":"California Medical Innovations Institute, San Diego, CA 92121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengjun","family":"Wang","sequence":"additional","affiliation":[{"name":"California Medical Innovations Institute, San Diego, CA 92121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ghassan S.","family":"Kassab","sequence":"additional","affiliation":[{"name":"California Medical Innovations Institute, San Diego, CA 92121, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1123-6428","authenticated-orcid":false,"given":"Lik Chuan","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Mechanical Engineering, Michigan State University, East Lansing, MI 48824, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Behradfar, E., Nygren, A., and Vigmond, E.J. (2014). The role of purkinje-myocardial coupling during ventricular arrhythmia: A modeling study. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0088000"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Jabbour, R.J., Behradfar, E., Debney, M., Nygren, A., Hartley, A., Efimov, I., Hocini, M., Peters, N.S., Ng, F.S., and Vigmond, E.J. (2025). Acute ischaemia and gap junction modulation modify propagation patterns across Purkinje-myocardial junctions. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1540400"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.pbiomolbio.2015.12.013","article-title":"Modeling our understanding of the His-Purkinje system","volume":"120","author":"Vigmond","year":"2016","journal-title":"Prog. Biophys. Mol. Biol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1161\/01.CIR.41.6.899","article-title":"Total excitation of the isolated human heart","volume":"41","author":"Durrer","year":"1970","journal-title":"Circulation"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.hrthm.2009.11.025","article-title":"Purkinje activation precedes myocardial activation following defibrillation after long-duration ventricular fibrillation","volume":"7","author":"Dosdall","year":"2010","journal-title":"Heart Rhythm"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1016\/j.ijcard.2018.11.005","article-title":"Left bundle branch block in dilated cardiomyopathy with intermediate left ventricular dysfunction: Clinical phenotyping and outcome correlates","volume":"278","author":"Gentile","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1559","DOI":"10.1136\/heartjnl-2018-314673","article-title":"Diagnosis of acute myocardial infarction in the presence of left bundle branch block","volume":"105","author":"Nestelberger","year":"2019","journal-title":"Heart"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"4161","DOI":"10.1093\/eurheartj\/ehac445","article-title":"Left bundle branch area pacing outcomes: The multicentre European MELOS study","volume":"43","author":"Cano","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.amjcard.2010.11.010","article-title":"Defining left bundle branch block in the era of cardiac resynchronization therapy","volume":"107","author":"Strauss","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1876","DOI":"10.1161\/CIRCULATIONAHA.118.038648","article-title":"Intracardiac Delineation of Septal Conduction in Left Bundle-Branch Block Patterns","volume":"139","author":"Upadhyay","year":"2019","journal-title":"Circulation"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1016\/j.jacc.2003.08.038","article-title":"Intra-left ventricular electromechanical asynchrony: A new independent predictor of severe cardiac events in heart failure patients","volume":"43","author":"Bader","year":"2004","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1001\/jamainternmed.2014.578","article-title":"Left anterior fascicular block and the risk of cardiovascular outcomes","volume":"174","author":"Nielsen","year":"2014","journal-title":"JAMA Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1161\/01.CIR.0000118502.91105.F6","article-title":"Characterization of Left Ventricular Activation in Patients with Heart Failure and Left Bundle-Branch Block","volume":"109","author":"Auricchio","year":"2004","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.hrthm.2014.12.031","article-title":"Electrical dyssynchrony induced by biventricular pacing: Implications for patient selection and therapy improvement","volume":"12","author":"Ploux","year":"2015","journal-title":"Heart Rhythm"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1056\/NEJMoa0906431","article-title":"Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events","volume":"361","author":"Moss","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"335","DOI":"10.1016\/j.tcm.2018.10.012","article-title":"Mechanism of harm from left bundle branch block","volume":"29","author":"Smiseth","year":"2019","journal-title":"Trends Cardiovasc. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"103460","DOI":"10.1016\/j.media.2025.103460","article-title":"Probabilistic learning of the Purkinje network from the electrocardiogram","volume":"101","author":"Pezzuto","year":"2025","journal-title":"Med. Image Anal."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"11788","DOI":"10.1038\/s41598-023-38653-1","article-title":"Enhanced optimization-based method for the generation of patient-specific models of Purkinje networks","volume":"13","author":"Berg","year":"2023","journal-title":"Sci. Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2455","DOI":"10.1016\/j.jbiomech.2015.12.025","article-title":"Generating Purkinje networks in the human heart","volume":"49","author":"Hurtado","year":"2016","journal-title":"J. Biomech."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2243","DOI":"10.1007\/s10439-012-0593-5","article-title":"A novel rule-based algorithm for assigning myocardial fiber orientation to computational heart models","volume":"40","author":"Bayer","year":"2012","journal-title":"Ann. Biomed. Eng."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1016\/j.yjmcc.2011.05.020","article-title":"Anatomical and molecular mapping of the left and right ventricular His-Purkinje conduction networks","volume":"51","author":"Atkinson","year":"2011","journal-title":"J. Mol. Cell. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1679\/aohc.72.139","article-title":"Morphological varieties of the purkinje fiber network in mammalian hearts, as revealed by light and electron microscopy","volume":"72","author":"Ono","year":"2009","journal-title":"Arch. Histol. Cytol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1007\/s12565-014-0255-9","article-title":"Ungulates heart model: A study of the Purkinje network using India ink injection, transparent specimens and computer tomography","volume":"90","author":"Lopes","year":"2015","journal-title":"Anat. Sci. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"481","DOI":"10.2170\/physiolsci.RP003208","article-title":"A procedural method for modeling the Purkinje fibers of the heart","volume":"58","author":"Ijiri","year":"2008","journal-title":"J. Physiol. Sci."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"7188","DOI":"10.1038\/s41598-017-07694-8","article-title":"High resolution 3-Dimensional imaging of the human cardiac conduction system from microanatomy to mathematical modeling","volume":"7","author":"Stephenson","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"664","DOI":"10.1111\/joa.12594","article-title":"A quantitative structural and morphometric analysis of the Purkinje network and the Purkinje\u2013myocardial junctions in pig hearts","volume":"230","author":"Sebastian","year":"2017","journal-title":"J. Anat."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s12265-021-10130-y","article-title":"Computational Modeling Studies of the Roles of Left Ventricular Geometry, Afterload, and Muscle Contractility on Myocardial Strains in Heart Failure with Preserved Ejection Fraction","volume":"14","author":"Shavik","year":"2021","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1016\/0960-0779(95)00089-5","article-title":"A Simple Two-variable Model of Cardiac Excitation","volume":"7","author":"Aliev","year":"1996","journal-title":"Chaos Solitons Fractals"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.euromechsol.2014.04.001","article-title":"The living heart project: A robust and integrative simulator for human heart function","volume":"48","author":"Baillargeon","year":"2014","journal-title":"Eur. J. Mech. A\/Solids"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"12670","DOI":"10.1038\/s41598-019-48670-8","article-title":"Model of Anisotropic Reverse Cardiac Growth in Mechanical Dyssynchrony","volume":"9","author":"Arumugam","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.cma.2017.03.015","article-title":"The importance of mechano-electrical feedback and inertia in cardiac electromechanics","volume":"320","author":"Concha","year":"2017","journal-title":"Comput. Methods Appl. Mech. Eng."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.pharmthera.2013.04.010","article-title":"Structure, function and clinical relevance of the cardiac conduction system, including the atrioventricular ring and outflow tract tissues","volume":"139","author":"Dobrzynski","year":"2013","journal-title":"Pharmacol. Ther."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1115\/1.2894084","article-title":"Passive Material Properties of Intact Ventricular Myocardium Determined From a Cylindrical Model","volume":"113","author":"Guccione","year":"1991","journal-title":"J. Biomech. Eng."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1115\/1.2895474","article-title":"Mechanics of actiwe contraction in cardiac muscle: Part II\u2014cylindrical models of the systolic left ventricle","volume":"115","author":"Guccione","year":"1993","journal-title":"J. Biomech. Eng."},{"key":"ref_35","first-page":"9","article-title":"The FEniCS Project Version 1.5","volume":"3","author":"Alnaes","year":"2015","journal-title":"Arch. Numer. Softw."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/B978-0-12-809657-4.99827-2","article-title":"Cardiac Anatomy, Physiology, and Pathophysiology","volume":"1\u20134","author":"Hor","year":"2018","journal-title":"Encycl. Cardiovasc. Res. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Stuyvers, B.D. (2025). Calcium arrhythmogenicity of Purkinje fibers: Importance of the animal model. Front. Physiol., 16.","DOI":"10.3389\/fphys.2025.1676701"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"103108","DOI":"10.1016\/j.media.2024.103108","article-title":"Digital twinning of the human ventricular activation sequence to Clinical 12-lead ECGs and magnetic resonance imaging using realistic Purkinje networks for in silico clinical trials","volume":"94","author":"Camps","year":"2024","journal-title":"Med. Image Anal."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/j.1540-8159.2008.02232.x","article-title":"Purkinje fibers and arrhythmias","volume":"32","author":"Ideker","year":"2009","journal-title":"Pacing Clin. Electrophysiol. PACE"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"414","DOI":"10.1152\/advan.00043.2020","article-title":"Understanding preload and preload reserve within the conceptual framework of a limited range of possible left ventricular end-diastolic volumes","volume":"44","author":"Peverill","year":"2020","journal-title":"Adv. Physiol. Educ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1161\/CIRCULATIONAHA.116.021955","article-title":"High-Resolution Mapping of Postinfarction Reentrant Ventricular Tachycardia: Electrophysiological Characterization of the Circuit","volume":"134","author":"Anter","year":"2016","journal-title":"Circulation"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jacc.2012.03.029","article-title":"Virtual electrophysiological study in a 3-dimensional cardiac magnetic resonance imaging model of porcine myocardial infarction","volume":"60","author":"Ng","year":"2012","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"364","DOI":"10.31083\/j.rcm2510364","article-title":"Progress of Conductivity and Conduction Velocity Measured in Human and Animal Hearts","volume":"25","author":"Fu","year":"2024","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1161\/01.CIR.73.1.189","article-title":"Changes in conduction velocity during acute ischemia in ventricular myocardium of the isolated porcine heart","volume":"73","author":"Kleber","year":"1986","journal-title":"Circulation"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/j.ihj.2017.10.013","article-title":"Three-dimensional echocardiographic evaluation of mechanical dyssynchrony in systolic heart failure with narrow QRS complex","volume":"70","author":"Bhambhani","year":"2018","journal-title":"Indian Heart J."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"e016090","DOI":"10.1161\/CIRCIMAGING.123.016090","article-title":"Meta-Analysis of Normal Reference Values for Right and Left Ventricular Quantification by Cardiovascular Magnetic Resonance","volume":"17","author":"Zhan","year":"2024","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_47","unstructured":"Ragosta, M. (2018). Textbook of Clinical Hemodynamics, Elsevier."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1016\/j.echo.2008.11.009","article-title":"Quantification of Left Ventricular Systolic Dyssynchrony by Real-Time Three-Dimensional Echocardiography","volume":"22","author":"Soliman","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"e229","DOI":"10.1016\/j.hrthm.2024.12.038","article-title":"Left bundle branch block\u2014Innocent bystander, silent menace, or both","volume":"22","author":"Lau","year":"2024","journal-title":"Heart Rhythm"},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Willerson, J.T. (2007). Cardiovascular Medicine, Springer. [3rd ed.].","DOI":"10.1007\/978-1-84628-715-2"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"981","DOI":"10.1161\/CIRCRESAHA.109.204891","article-title":"Transmural dispersion of repolarization in failing and nonfailing human ventricle","volume":"106","author":"Glukhov","year":"2010","journal-title":"Circ. Res."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"H545","DOI":"10.1152\/ajpheart.00159.2016","article-title":"Ventricular stimulus site influences dynamic dispersion of repolarization in the intact human heart","volume":"311","author":"Srinivasan","year":"2016","journal-title":"Am. J. Physiol.-Heart Circ. Physiol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1016\/j.jacc.2013.01.093","article-title":"Noninvasive electrocardiographic mapping to improve patient selection for cardiac resynchronization therapy: Beyond QRS duration and left bundle branch block morphology","volume":"61","author":"Ploux","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1631\/jzus.B1700029","article-title":"Electrocardiogram (ECG) patterns of left anterior fascicular block and conduction impairment in ventricular myocardium: A whole-heart model-based simulation study","volume":"19","author":"Gao","year":"2018","journal-title":"J. Zhejiang Univ. Sci. B"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1093\/ehjci\/jev006","article-title":"Myocardial strain measurement with feature-tracking cardiovascular magnetic resonance: Normal values","volume":"16","author":"Taylor","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1016\/j.cardfail.2016.06.148","article-title":"Changes in Mechanical Dyssynchrony in Severe Aortic Stenosis Patients Undergoing Transcatheter Aortic Valve Replacement","volume":"22","author":"Truong","year":"2016","journal-title":"J. Card. Fail."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1161\/CIRCULATIONAHA.104.474445","article-title":"Real-time three-dimensional echocardiography: A novel technique to quantify global left ventricular mechanical dyssynchrony","volume":"112","author":"Kapetanakis","year":"2005","journal-title":"Circulation"},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Landsberg, J.W. (2018). Heart failure for the pulmonary critical care physician. Clinical Practice Manual for Pulmonary and Critical Care Medicine, Elsevier.","DOI":"10.1016\/B978-0-323-39952-4.00006-8"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"iv94","DOI":"10.1093\/europace\/euw355","article-title":"New insights froma computationalmodel on the relation between pacing site and CRT response","volume":"18","author":"Pluijmert","year":"2016","journal-title":"Europace"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S0022-0736(80)80045-8","article-title":"Effects of left anterior fascicular block on the depolarization process as depicted by total body surface mapping","volume":"13","author":"Sohi","year":"1980","journal-title":"J. Electrocardiol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1016\/j.hrthm.2008.05.021","article-title":"Real-time three-dimensional echocardiography as a novel approach to assess left ventricular and left atrium reverse remodeling and to predict response to cardiac resynchronization therapy","volume":"5","author":"Marsan","year":"2008","journal-title":"Heart Rhythm"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1093\/ejechocard\/jeq095","article-title":"Real-time three-dimensional speckle tracking echocardiography: A novel technique to quantify global left ventricular mechanical dyssynchrony","volume":"12","author":"Thebault","year":"2011","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jcmg.2010.09.021","article-title":"Real-time 3D echo in patient selection for cardiac resynchronization therapy","volume":"4","author":"Kapetanakis","year":"2011","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"P175","DOI":"10.1186\/1532-429X-13-S1-P175","article-title":"Systolic Dyssynchrony Index derived from cardiac magnetic resonance imaging predicts left ventricular remodeling in heart failure patients undergoing CRT","volume":"13","author":"Duckett","year":"2011","journal-title":"J. Cardiovasc. Magn. Reson."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"e008239","DOI":"10.1161\/CIRCEP.119.008239","article-title":"Left Bundle Branch Block: Current and Future Perspectives","volume":"13","author":"Tan","year":"2020","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1080","DOI":"10.1002\/ejhf.2524","article-title":"The effect of cardiac resynchronization without a defibrillator on morbidity and mortality: An individual patient data meta-analysis of COMPANION and CARE-HF","volume":"24","author":"Cleland","year":"2022","journal-title":"Eur. J. Heart Fail."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.jcmg.2017.11.025","article-title":"Afterload Hypersensitivity in Patients With Left Bundle Branch Block","volume":"12","author":"Aalen","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1109\/TMI.2006.872746","article-title":"An electromechanical model of the heart for image analysis and simulation","volume":"25","author":"Sermesant","year":"2006","journal-title":"IEEE Trans. Med. Imaging"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"732","DOI":"10.1038\/s41551-018-0282-2","article-title":"Personalized virtual-heart technology for guiding the ablation of infarct-related ventricular tachycardia","volume":"2","author":"Prakosa","year":"2018","journal-title":"Nat. Biomed. Eng."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1007\/s12265-017-9779-4","article-title":"Computational modeling for cardiac resynchronization therapy","volume":"11","author":"Lee","year":"2018","journal-title":"J. Cardiovasc. Transl. Res."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"1922","DOI":"10.1016\/j.hrthm.2020.06.028","article-title":"His-bundle and left bundle pacing with optimized atrioventricular delay achieve superior electrical synchrony over endocardial and epicardial pacing in left bundle branch block patients","volume":"17","author":"Strocchi","year":"2020","journal-title":"Heart Rhythm"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"3143","DOI":"10.1007\/s10439-021-02825-9","article-title":"Automated Framework for the Inclusion of a His\u2013Purkinje System in Cardiac Digital Twins of Ventricular Electrophysiology","volume":"49","author":"Gillette","year":"2021","journal-title":"Ann. Biomed. Eng."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1885","DOI":"10.1016\/j.jacep.2024.04.004","article-title":"Retrograde Conduction in Left Bundle Branch Block","volume":"10","author":"Ponnusamy","year":"2024","journal-title":"JACC Clin. Electrophysiol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/S0045-7825(99)00059-6","article-title":"A stabilized mixed finite element method for finite elasticity: Formulation for linear displacement and pressure interpolation","volume":"180","author":"Klaas","year":"1999","journal-title":"Comput. Methods Appl. Mech. Eng."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"111083","DOI":"10.1016\/j.jcp.2022.111083","article-title":"A cardiac electromechanical model coupled with a lumped-parameter model for closed-loop blood circulation","volume":"457","author":"Regazzoni","year":"2022","journal-title":"J. Comput. Phys."}],"container-title":["Bioengineering"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/464\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T04:14:25Z","timestamp":1776399265000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2306-5354\/13\/4\/464"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":75,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["bioengineering13040464"],"URL":"https:\/\/doi.org\/10.3390\/bioengineering13040464","relation":{},"ISSN":["2306-5354"],"issn-type":[{"value":"2306-5354","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]}}}