Optimization of Endocardial Electrode Positions to Enhance Cardiac Resynchronization Therapy Response: an in-Silico Study

Cardiac resynchronization therapy (CRT) is one of the recommended therapies for patients with chronic heart failure. Unfortunately, about 30% of CRT device implantation can not improve heart performance. Modern wireless pacemakers and alternative approach for endocardial LV leads can apply pacing stimulus at an arbitrary location in the left ventricular endocardial wall. This provides an opportunity to increase the efficiency of CRT and outperform the conventional CRT procedure with LV CRT lead position at the epicardial surface of the left ventricular wall. In this in-silico study, we analyze the possibility for an optimal position of the electrodes at the endocardial surfaces of the right ventricle and left ventricle for the maximal efficiency of CRT. Computations are performed with 35 patient-specific models of the human heart, lungs, and torso. Eikonal and ionic TP06 models are used for modelling the myocardial electrophysiology. As a result, we found three pairs of electrode positions that can provide an optimal outcome for a major part of the patient-specific models.