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Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart

Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart
Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart
Background: Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but approximately 30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial (Endo) and multisite epicardial (TriV) pacing have been proposed as alternatives to traditional LV transvenous epicardial (Epi) pacing, but no study has directly compared the hemodynamic effects of these approaches.

Methods and Results: Left bundle branch block (LBBB) ablation was performed and repeated microembolizations were performed in dogs to reduce LV ejection fraction (EF) to less than 35%. LV dP/dtmax and other hemodynamic indices were measured with a conductance catheter during LV Epi, LV Endo, Biventricular (BiV) Epi, BiV Endo and TriV pacing performed at 3 AV delays. LV Endo pacing was obtained with a clinically-available pacing system. The optimal site was defined as the site that increased dP/dtmax by the largest percentage. Implantation of the Endo lead was feasible in all canines (n=8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV Endo pacing sites. BiV Endo pacing increased dP/dtmax more than BiV Epi and TriV pacing on average (p<.01) and at the optimal site (p<.01). There were no significant differences between BiV Epi and TriV pacing.

Conclusions: BiV Endo pacing was superior to BiV Epi and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.
cardiac resynchronization therapy, endocardial pacing, multisite pacing, dogs
0363-6135
Bordacher, Pierre
90c434d3-0b9b-4345-b311-fa15588f252a
Grenz, Nathan
3b33672e-e8c7-431b-97c5-8f09a9bb5448
Jais, Pierre
d4b82e6f-204f-4233-9a8a-e368f30224e1
Ritter, Philippe
b6db7686-8fd5-444d-aac4-c48bb75c1583
Leclercq, Christophe
0358d7f0-0e2b-423d-bdc0-74639a3cfacc
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Gras, Daniel
1837c7be-a90a-4019-a9bc-40bf78e1f8e9
Yang, Ping
3dba2634-eb2b-4df8-a995-1061b841afe1
Bordacher, Pierre
90c434d3-0b9b-4345-b311-fa15588f252a
Grenz, Nathan
3b33672e-e8c7-431b-97c5-8f09a9bb5448
Jais, Pierre
d4b82e6f-204f-4233-9a8a-e368f30224e1
Ritter, Philippe
b6db7686-8fd5-444d-aac4-c48bb75c1583
Leclercq, Christophe
0358d7f0-0e2b-423d-bdc0-74639a3cfacc
Morgan, John M.
ac98099e-241d-4551-bc98-709f6dfc8680
Gras, Daniel
1837c7be-a90a-4019-a9bc-40bf78e1f8e9
Yang, Ping
3dba2634-eb2b-4df8-a995-1061b841afe1

Bordacher, Pierre, Grenz, Nathan, Jais, Pierre, Ritter, Philippe, Leclercq, Christophe, Morgan, John M., Gras, Daniel and Yang, Ping (2012) Left ventricular endocardial or triventricular pacing to optimize cardiac resynchronization therapy in a chronic canine model of ischemic heart. American Journal of Physiology: Heart and Circulatory Physiology. (doi:10.1152/ajpheart.01117.2011).

Record type: Article

Abstract

Background: Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but approximately 30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial (Endo) and multisite epicardial (TriV) pacing have been proposed as alternatives to traditional LV transvenous epicardial (Epi) pacing, but no study has directly compared the hemodynamic effects of these approaches.

Methods and Results: Left bundle branch block (LBBB) ablation was performed and repeated microembolizations were performed in dogs to reduce LV ejection fraction (EF) to less than 35%. LV dP/dtmax and other hemodynamic indices were measured with a conductance catheter during LV Epi, LV Endo, Biventricular (BiV) Epi, BiV Endo and TriV pacing performed at 3 AV delays. LV Endo pacing was obtained with a clinically-available pacing system. The optimal site was defined as the site that increased dP/dtmax by the largest percentage. Implantation of the Endo lead was feasible in all canines (n=8) without increased mitral regurgitation seen with transesophageal echocardiography and with full access to the different LV Endo pacing sites. BiV Endo pacing increased dP/dtmax more than BiV Epi and TriV pacing on average (p<.01) and at the optimal site (p<.01). There were no significant differences between BiV Epi and TriV pacing.

Conclusions: BiV Endo pacing was superior to BiV Epi and to TriV pacing in terms of acute hemodynamic response. Further investigation is needed to confirm the chronic benefit of this approach in humans.

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More information

Accepted/In Press date: 2012
e-pub ahead of print date: 4 May 2012
Keywords: cardiac resynchronization therapy, endocardial pacing, multisite pacing, dogs
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 338785
URI: https://eprints.soton.ac.uk/id/eprint/338785
ISSN: 0363-6135
PURE UUID: 2e16bd4a-622b-4726-bf11-aa5d6e01763b

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Date deposited: 17 May 2012 10:51
Last modified: 18 Jul 2017 05:57

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Contributors

Author: Pierre Bordacher
Author: Nathan Grenz
Author: Pierre Jais
Author: Philippe Ritter
Author: Christophe Leclercq
Author: John M. Morgan
Author: Daniel Gras
Author: Ping Yang

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