Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.

心脏再同步治疗（CRT）可以大大改善不同步的心力衰竭并降低死亡率。但是，约有三分之一的植入患者没有从CRT获得可衡量的益处。无反应可能部分是由于电生理异质性导致左心室（LV）激活欠佳。这项研究的目的是研究一种新方法的性能，该方法用于分析心脏模型（包括心肌瘢痕）中的电波前传播，并将其与临床基准研究进行比较。我们使用计算模型来测量不同起搏场景下左心室的最大激活前沿（MAF）。基于三位患者的心脏MR图像创建了不同的心脏几何形状和疤痕​​。右心室（RV）从心尖起搏，左心室从12个不同部位起搏，分别是单部位，双部位和三部位。我们的结果表明，对于单LV部位起搏，具有最大MAF的起搏部位与RV起搏期间显示的LV的最新激活区域相对应，这也与先前用于预测最佳单部位起搏位置的标记相吻合。然后，我们证明了MAF在预测更复杂的情况下（包括疤痕和多部位LV起搏）的最佳电极位置的实用性。这项研究表明了计算模拟在理解和计划CRT中的潜在价值。具有最大MAF的起搏部位与RV起搏期间显示的LV的最新激活区域相对应，这也与以前用于预测最佳单部位起搏位置的标记相吻合。然后，我们证明了MAF在预测更复杂的情况下（包括疤痕和多部位LV起搏）的最佳电极位置的实用性。这项研究表明了计算模拟在理解和计划CRT中的潜在价值。具有最大MAF的起搏部位与RV起搏期间显示的LV的最新激活区域相对应，这也与以前用于预测最佳单部位起搏位置的标记相吻合。然后，我们证明了MAF在预测更复杂的情况下（包括疤痕和多部位LV起搏）的最佳电极位置的实用性。这项研究表明了计算模拟在理解和计划CRT中的潜在价值。