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Updated: Aug 23, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Comparative study of the effect of pacing mode on the interaction of the right and left ventricles
Noboru Mizutani1, Katsuhisa Waseda, Takayuki Itou
1Division of Cardiology, Department of Medicine, Aichi Medical University School of Medicine, 21 Karimata, Yazako, Nagakute, Aichi-gun, Aichi 480-1195, Japan. 100506@gk.amu.aichi-med-u.ac.jp
Insights
Ventricular dyssynchrony can occur with VVI and DVI pacing, indicated by a dual-peak waveform in right ventricular pressure. Minimizing this dual-peak distance is crucial for synchronizing heart contractions, especially in heart failure patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- Ventricular dyssynchrony impacts cardiac function.
- Understanding right and left ventricular interaction is key.
Purpose of the Study:
- To evaluate ventricular dyssynchrony based on right and left ventricular contraction interactions.
- To analyze hemodynamic differences across various pacing modes.
Main Methods:
- Simultaneous recording of left and right ventricular pressure and dp/dt using microtip transducer catheters.
- Analysis of hemodynamic data in patients with sick sinus syndrome, atrioventricular block, and normal sinus rhythm.
Main Results:
- A dual-peak waveform in right ventricular positive peak dp/dt indicated ventricular dyssynchrony.
- This dual-peak waveform was observed during ventricular (VVI) and atrioventricular sequential (DVI) pacing.
- A single-peak waveform was noted during atrial (AAI) pacing or sinus rhythm.
Conclusions:
- VVI and DVI pacing can lead to asynchronous ventricular contractions, evidenced by a dual-peak right ventricular dp/dt.
- Reducing the interval between the dual peaks of the right ventricular dp/dt may improve ventricular synchronization.
- Consideration of this finding is vital for managing chronic heart failure patients with left bundle branch block requiring biventricular pacing.
Abstract:
This study was designed to evaluate ventricular dyssynchrony from the viewpoint of the interaction of right and left ventricular contractions. Forty-three patients, 24 with sick sinus syndrome, 9 with complete atrioventricular block, and 10 with normal sinus rhythm were involved in this study. Microtip transducer catheters were advanced into both the left and right ventricles and ventricular pressure and the associated dp/dt were recorded simultaneously. Hemodynamic differences in various pacing modes were analyzed using pressure and dp/dt recordings obtained from the left and right ventricles. When an asynchrony between the right and left ventricular contractions existed, the right ventricular positive peak dp/dt developed a dual-peak waveform, the second peak corresponding in time to the peak of the left ventricular positive peak dp/dt. This dual-peak dp/dt waveform was seen with ventricular (VVI) and atrioventricular sequential (DVI) pacing, whereas a single-peak waveform was seen with atrial (AAI) pacing or sinus rhythm. In cases where DVI or VVI pacing modes are selected, an asynchronous effect between contractions of the right and left ventricles may occur, with dual-peak dp/dt of the right ventricle. Because the dual-peak dp/dt waveform indicates ventricular dyssynchrony, reducing the distance from peak I to peak II could maintain the synchronization of the right and left ventricles. It is considered particularly vital to give sufficient consideration to this point in chronic heart failure patients with left bundle branch block requiring biventricular pacing.
