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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

View larger version (68K): [in a new window]   Figure 1 Schematic representation of position of pacing electrodes. Black dots denote epicardial electrodes, A = anterior, L = lateral, and P = posterior left ventricular (LV) wall electrode. The LV septal (LVs) electrode was positioned by pushing the barbed electrode inside a needle through the right ventricular (RV) free wall and the septum, so that the barbed tip attached to the LV endocardial surface of the septum. RVs = RV septum. For further details see Methods section.

View larger version (22K): [in a new window]   Figure 2 Pressure-volume diagrams during sinus rhythm (SR) (dotted line) and during pacing from the left ventricular (LV) apex (thick drawn line), and LV lateral wall (lat) (dot-dash line), and from the right ventricular (RV) apex (broken line).

View larger version (25K): [in a new window]   Figure 3 (Upper panel) Pressure-volume diagrams during sinus rhythm (SR), left ventricular (LV) apex pacing, biventricular (BiV) pacing, multi-LV pacing, and multi LV + right ventricular (RV) pacing. (Lower panels) Mean values ± SD of maximal rate of rise of LV pressure (LVdP/dtpos) and stroke work (SW) during LV apex, BiV, multi-LV, and multi-LV + RV pacing relative to SR. Differences in SW and LVdP/dtpos between the four pacing modes were not statistically significant.

View larger version (30K): [in a new window]   Figure 4 (Upper panel) Pressure-volume diagrams during sinus rhythm (SR) and pacing at the low, mid-, mid-high, and high-right ventricular (RV) septum. (Lower panels) Mean values ± SD of maximal rate of rise of left ventricular (LV) pressure (LVdP/dtpos) and stroke work (SW) during pacing at the RV apex and the various RV septal sites relative to SR. Differences in SW and LVdP/dtpos between the five pacing modes were not statistically significant, but SW was significantly lower than SR during pacing at all five sites, and LVdP/dtpos was significantly below SR during low and high septal pacing.

View larger version (26K): [in a new window]   Figure 5 Individual values of maximal rate of rise of left ventricular pressure (LVdP/dtpos) (left panel) and stroke work (SW) (right panel), relative to sinus rhythm (SR), as a function of the site of pacing at the right ventricular (RV) septal wall. Each symbol represents one experiment. Some datapoints are missing due to unstable pacing at some RV septal sites.

View larger version (23K): [in a new window]   Figure 6 Pressure-volume diagrams during sinus rhythm (SR) and pacing at the left ventricular (LV) apex and LV septal endocardium.