Left ventricular mechanics during right ventricular apical or left ventricular-based pacing in patients with chronic atrial fibrillation after atrioventricular junction ablation
Emmanuel N. Simantirakis, MD*,
Konstantinos E. Vardakis, MD*,
George E. Kochiadakis, MD*,
Emmanuel G. Manios, MD*,
Nikolaos E. Igoumenidis, MD*,
Michele Brignole, MD and
Panos E. Vardas, MD, PhD, FACC*,*
* Cardiology Department, Heraklion University Hospital, Crete, Greece
Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
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Figure 1 An example of pressure–volume loops obtained by transient occlusion of the inferior vena cava using a vascular occlusion balloon catheter during right ventricular apical (A), left ventricular free wall (B), and biventricular pacing (C) in one of our patients with normal left ventricular systolic function. The end-systolic pressure–volume relation line slope clearly increased during left ventricular free wall and biventricular pacing.
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Figure 2 Signal-averaged data of left ventricular pressure–volume loops at baseline (before the beginning of the inflation of vascular occlusion balloon) during right ventricular apical (A), left ventricular free wall (B), and biventricular pacing (C) in the patient of Figure 1. Left ventricular–based pacing consistently shifted the end-systolic pressure–volume point upwards and to the left, and the end-diastolic pressure–volume point downwards and to the right. The area of the entire loop increased, indicating that left ventricular free wall and biventricular pacing produce a more effective contraction than does conventional right ventricular apical pacing.
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