Biology subjects

Dosdall, D.

Publications and source records attributed to Dosdall, D..

3 recordsLinked to original sources

bioRxiv2025

Left Bundle Branch Area Pacing Preserves Mechanical Strain and Synchrony Compared to Right Ventricular Apical Pacing in an Acute Paired Preclinical Model

BackgroundLeft bundle branch area (LBBA) pacing is emerging as a promising alternative to conventional right ventricular (RV) pacing, particularly in its ability to maintain physiological ventricular activation and enhance cardiac function. However, the effect of LBBA pacing on changes to left ventricular (LV) function in paired experiments on healthy hearts, particularly in relation to myocardial strain and time to peak systolic strain difference (TPSD), which are critical indicators of LV dysfunction, remains inadequately understood. ObjectiveTo investigate how the LV myocardial strain and TPSD change in a comparative study of LBBA pacing versus conventional RV apex pacing in the same hearts under normal physiological conditions. MethodsPre-clinical canine models (n=7) were implanted with pacing leads in the LBBA and RV apex. Functional parameters were assessed under acute pacing conditions and during sinus rhythm (SR) with echocardiographic assessment. ResultsResults demonstrated that LBBA pacing significantly improved global longitudinal strain (GLS: -13{+/-}2% vs. -9{+/-}2%, p = 0.0003) and global circumferential strain (GCS: -16{+/-}3% vs. -10{+/-}4%, p = 0.0119) compared to RV apical pacing. TPSD was significantly greater with RV pacing (65{+/-}10 ms vs. 24{+/-}7 ms, p = 0.0024). Compared with SR data, LBBA pacing showed no significant changes in GLS, GCS, or TPSD. ConclusionThese findings suggest that LBBA pacing effectively preserves global myocardial strain and TPSD close to their values in SR, thereby contributing to enhanced overall LV function, as evidenced by improvements in ejection fraction, end-systolic volume, and end-diastolic volume.

physiology↗

bioRxiv2025

Effect of Lead Body and Helix Design Variables on Implantation Success, Insertion Depth, and Muscle Torque in Left Bundle Branch Area: Insights from An Ex-Vivo Porcine Model

BackgroundLumenless and stylet-driven leads used for left bundle branch area pacing differ in design and have a significant implantation learning curve. While prior studies examined longer helices for deep septal pacing, the influence of other design variables remains unclear. ObjectiveTo evaluate how helix design and axial force affect interventricular septum insertion efficacy. MethodsRigid leads were developed using helical coils with variable outer diameter, number of turns and pitch. Porcine septa (n=16) were clamped perpendicularly for insertion using an optimized rotation-response system. Axial force simulating lumenless (30g) or stylet-driven (60g) leads was applied, and a fixed number of rotations were delivered at a constant rate. Each helix design (n=8) was tested 3x per axial force at three septal sites. Insertion depth, muscle-torque and visual feedback were recorded. Insertion was successful if depth exceeded coil length without surface entanglement. Effects of design factors were compared. ResultsAt 30g, more helix turns significantly improved insertion success (P=0.04), while fewer turns frequently produced entangled failure (P=0.04) marked by high torque variability (P<0.001). Smaller-pitch helices trended toward higher torque and success, whereas larger pitch achieved greater depth (P=0.05). Larger outer diameters also trended toward higher torque and improved success at 30g. At 60g the influence of helix design variable diminished and consistently yielded higher than at 30g. ConclusionAn optimized lead rotation-to-translation system elucidates how helix geometry and axial force interact during septal insertion. These interactions are explainable using an intuitive mechanical framework which is helpful for optimizing lead design.

bioengineering↗

bioRxiv2025

Antitachycardia Pacing is More Effective When Delivered to the Left Bundle Branch Area Compared to the Right Ventricle in a Pre-clinical Model of Ischemic Ventricular Tachycardia

BackgroundAnti-tachycardia pacing (ATP) delivered from implantable cardioverter defibrillators (ICDs) provides critically timed pacing pulses to terminate ventricular tachycardia (VT). Physiological pacing through left bundle branch area (LBBA) pacing has emerged as a clinically relevant alternative to induce synchronous activation of the ventricles. The main objective of this study was to compare the efficacy and safety of ATP delivered to an LBBA lead and a conventional RV lead. MethodsUsing a preclinical animal model (n=7), pacing leads were implanted in the RV apex and LBBA and connected to ICDs. The left anterior descending artery was occluded for two hours to cause an ischemia-reperfusion injury (IRI). Four days following IRI, VT episodes were induced using programmed electrical stimulation (PES), and burst ATP therapy was delivered to the RV or LBBA leads for each VT episode. ResultsVT was induced 80 times, with a mean VT cycle length (VT CL) of 180.0{+/-}30.0 ms. ATP delivered to the LBBA terminated VT more often than RV ATP (70.2% vs 47.3%, P = 0.04), and there was no significant difference in negative outcomes of VT acceleration or VF induction. Activation sequences from the basket catheter were determined for the pre-therapy VT and captured ATP beats, and correlation coefficients were computed to the activation sequences during ATP delivery. The number of ATP pulses required for the activation sequences to correlate with the captured ATP pattern rather than the pre-therapy VT pattern was lower for LBBA ATP compared to RV ATP (4.1 vs. 5.1 beats, P = 0.04). Successful LBBA ATP demonstrated earlier and more frequent Purkinje activations preceding myocardial activation than successful RV ATP. ConclusionImproved performance of LBBA ATP compared to RV ATP provides further incentive for the wide use of LBBA leads in patients who need cardiac electrotherapy.

bioengineering↗