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Mills RW, Cornelussen RN, Mulligan LJ, Strik M, Rademakers LM, Skadsberg ND, van Hunnik A, Kuiper M, Lampert A, Delhaas T, Prinzen FW. Left Ventricular Septal and Left Ventricular Apical Pacing Chronically Maintain Cardiac Contractile Coordination, Pump Function and Efficiency. Circ Arrhythm Electrophysiol 2009; 2:571-9. [DOI: 10.1161/circep.109.882910] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Conventional right ventricular (RV) apex pacing can lead to adverse clinical outcome associated with asynchronous activation and reduced left ventricular (LV) pump function. We investigated to what extent alternate RV (septum) and LV (septum, apex) pacing sites improve LV electric activation, mechanics, hemodynamic performance, and efficiency over 4 months of pacing.
Methods and Results—
After AV nodal ablation, mongrel dogs were randomized to receive 16 weeks of VDD pacing at the RV apex, RV septum, LV apex, or LV septum (transventricular septal approach). Electric activation maps (combined epicardial contact and endocardial noncontact) showed that RV apical and RV septal pacing induced significantly greater electric desynchronization than LV apical and LV septal pacing. RV apex and RV septal pacing also significantly increased mechanical dyssynchrony, discoordination (MRI tagging) and blood flow redistribution (microspheres) and reduced LV contractility, relaxation, and myocardial efficiency (stroke work/myocardial oxygen consumption). In contrast, LV apical and LV septal pacing did not significantly alter these parameters as compared with the values during intrinsic conduction. At 16 weeks, acute intrasubject comparison showed that single-site LV apical and LV septal pacing generally resulted in similar or better contractility, relaxation, and efficiency as compared with acute biventricular pacing.
Conclusions—
Acute and chronic LV apical and LV septal pacing maintain regional cardiac mechanics, contractility, relaxation, and efficiency near native levels, whereas RV apical or RV septal pacing diminish these variables. Acute LV apical and LV septal pacing tend to maintain or improve contractility and efficiency compared with biventricular pacing.
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Affiliation(s)
- Robert W. Mills
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Richard N. Cornelussen
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Lawrence J. Mulligan
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Marc Strik
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Leonard M. Rademakers
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Nicholas D. Skadsberg
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Arne van Hunnik
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Marion Kuiper
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Anniek Lampert
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Tammo Delhaas
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
| | - Frits W. Prinzen
- From the Departments of Physiology, Pediatrics, and Cardiothoracic Surgery (R.W.M., R.N.C., M.S., L.M.R., A.v.H., M.K., A.L., T.D., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands; Bakken Research Center (R.N.C.), Medtronic, BV, Maastricht, The Netherlands; and Medtronic, Inc (L.J.M., N.D.S.), Minneapolis, Minn
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