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Updated: Aug 18, 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
Comparison of stimulation sites within left ventricular veins on the acute hemodynamic effects of cardiac
Michael R Gold1, Angelo Auricchio, John D Hummel
1Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina 29425, USA. goldmr@musc.edu
Objectives:
The purpose of this study was to study the acute hemodynamic effect of left ventricular (LV) stimulation sites within a coronary vein.
Background:
Access to LV stimulation sites for resynchronization therapy is achieved using specialized lead systems navigated through a coronary vein. The effects of stimulation in different coronary veins have been evaluated previously, but less is known about stimulation sites within a coronary vein.
Methods:
Twenty-four patients (New York Heart Association functional class II-IV, age 59 +/- 10 years, ejection fraction 21 +/- 7%, QRS 166 +/- 30 ms) were enrolled in the study. A novel over-the-wire lead system was used to access an anterior or lateral coronary vein. At each lead location, a randomized stimulation protocol was executed. Hemodynamic responses were evaluated using LV dP/dtmax.
Results:
The mean time to cannulate the coronary sinus and position the LV lead was 19 +/- 30 minutes and 17 +/- 18 minutes, respectively. Data from stimulation at two sites within a coronary vein were obtained in 19 patients (anterior vein 11; lateral vein 8). Of these patients, 14 (anterior vein 9; lateral vein 5) showed large improvement in dP/dtmax (22%-25% in anterior vein, 37%-40% in lateral vein). Overall, there were no group differences in hemodynamic effects among different stimulation sites within a coronary vein, although significant variability among sites was observed in individuals.
Conclusions:
Resynchronization therapy through a coronary vein improves acute hemodynamic function of heart failure patients with LV conduction disorder. There were no significant differences between basal and apical pacing sites for this group.
