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CLINICAL STUDY

Left ventricular septal and apex pacing for optimal pump function in canine hearts

Maaike Peschar, PhD^*, Hans de Swart, MD, Koen J. Michels, MSc, Ing, Robert S. Reneman, MD, PhD^* and Frits W. Prinzen, PhD^*,*

^* Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
Medtronic, Bakken Research Center, Maastricht, the Netherlands

Manuscript received May 29, 2002; revised manuscript received October 8, 2002, accepted November 27, 2002.

^* Reprint requests and correspondence: Dr. Frits W. Prinzen, Department of Physiology, Cardiovascular Research Institute Maastricht, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.
frits.prinzen{at}fys.unimaas.nl

OBJECTIVES: The goal of this study was to test the hypothesis that left ventricular (LV) pump function is optimal when pacing is performed at the LV near the sites where the impulses exit the Purkinje system.

BACKGROUND: Pacing at the conventional site, the right ventricular (RV) apex, adversely affects hemodynamics. During normal sinus rhythm (SR), electrical activation of the working myocardium starts at the LV septal endocardium and spreads from apex to base.

METHODS: Experiments were conducted in anesthetized open-chest dogs with normal ventricular conduction to investigate hemodynamic effects of pacing at various epicardial LV sites, the RV apex, and combinations of these sites (n = 11) and of RV and LV septal pacing (n = 8). The LV septal endocardium was reached via the RV by puncturing through the septum with a barbed electrode. Left ventricular systolic (LVdP/dtpos and stroke work) and diastolic (LVdP/dtneg and Tau) function were assessed using pressure-volume relations (conductance catheter technique).

RESULTS: Left ventricular systolic and diastolic function were highly dependent on the site of pacing, but not on QRS duration. Left ventricular function was maintained at SR level during LV septal, LV apex, and multisite pacing, was moderately depressed during pacing at epicardial LV free wall sites, and was most severely depressed during RV apex pacing. On average, RV septal pacing did not improve LV function, compared with RV apex pacing, but in each experiment one (variable) RV pacing site was found, which only moderately reduced LV function.

CONCLUSIONS: During ventricular pacing, LV pump function is maintained best (i.e., at SR level) when pacing at the LV septum or LV apex, potentially because pacing from these sites creates a physiological propagation of electrical conduction.

Abbreviations and Acronyms   AV = atrioventricular   LV = left ventricle/ventricular   LVdP/dtneg = maximal rate of fall of left ventricular pressure   LVdP/dtpos = maximal rate of rise of left ventricular pressure   RV = right ventricle/ventricular   SR = sinus rhythm   SV = stroke volume   SW = stroke work

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