TY - JOUR
T1 - Comparative electromechanical and hemodynamic effects of left ventricular and biventricular pacing in dyssynchronous heart failure
T2 - Electrical resynchronization versus left-right ventricular interaction
AU - Lumens, Joost
AU - Ploux, Sylvain
AU - Strik, Marc
AU - Gorcsan, John
AU - Cochet, Hubert
AU - Derval, Nicolas
AU - Strom, Maria
AU - Ramanathan, Charu
AU - Ritter, Philippe
AU - Haïssaguerre, Michel
AU - Jaïs, Pierre
AU - Arts, Theo
AU - Delhaas, Tammo
AU - Prinzen, Frits W.
AU - Bordachar, Pierre
N1 - Funding Information:
This research was performed within the framework of CTMM, the Center for Translational Molecular Medicine, project COHFAR (grant 01C-203 ) cofunded by the Dutch Heart Foundation . The study was supported by the French Government, Agence National de la Recherche au titre du programme Investissements d'Avenir ( ANR-10-IAHU-04 ). Dr. Lumens received a grant within the framework of the Dr. E. Dekker program of the Dutch Heart Foundation ( NHS-2012T010 ). Dr. Ploux was financially supported by “la Fédération Française de Cardiologie.” Dr. Gorcsan has received research grants from Biotronik , Medtronic , Toshiba , and St. Jude Medical ; and is a consultant for CardioInsight Technologies Inc, GE, Toshiba, Biotronik, Medtronic, and St. Jude Medical. Drs. Strom and Ramanathan are paid employees and stock owners of CardioInsight Technologies Inc. Dr. Ritter has served as a consultant for Sorin CRM and Medtronic and has received consultant honoraria. Drs. Haïssaguerre and Jaïs are stock owners of CardioInsight Technologies Inc. Dr. Prinzen has received research grants from Medtronic , EBR Systems , and Merck Sharp & Dohme . All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2013/12/24
Y1 - 2013/12/24
N2 - Objectives The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP). Background It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure. Methods Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dt max]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique. Results LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone. Conclusions Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy.
AB - Objectives The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP). Background It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure. Methods Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dt max]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique. Results LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone. Conclusions Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy.
UR - http://www.scopus.com/inward/record.url?scp=84890710246&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84890710246&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2013.08.715
DO - 10.1016/j.jacc.2013.08.715
M3 - Article
AN - SCOPUS:84890710246
SN - 0735-1097
VL - 62
SP - 2395
EP - 2403
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 25
ER -