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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing

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Coupled pacing improves left ventricular function during simulated atrial fibrillation without mechanical

Pascal Lim¹, George E Yanulis, David Verhaert

¹Department of Cardiovascular Medicine, APHP, Henri Mondor University Hospital, 51 Av. de Lattre de Tassigny, Creteil 94 010, France. pascal.lim@hmn.aphp.fr

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology

|February 2, 2010

Summary

Coupled pacing (CP) combined with cardiac resynchronization therapy (CRT) effectively controls rapid heart rates during atrial fibrillation. This combined therapy improves heart function and blood flow without causing mechanical dyssynchrony.

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Sterile Pericarditis in Aachener Minipigs As a Model for Atrial Myopathy and Atrial Fibrillation

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Published on: September 24, 2021

Area of Science:

Cardiology
Electrophysiology
Heart Failure Management

Background:

Atrial fibrillation (AF) can lead to rapid ventricular rates, impacting cardiac function.
Cardiac resynchronization therapy (CRT) is used to improve heart function in certain patients.
Coupled pacing (CP) aims to prevent rapid ventricular conduction by creating retrograde atrioventricular node activation.

Purpose of the Study:

To evaluate the impact of combining coupled pacing (CP) with cardiac resynchronization therapy (CRT) in managing atrial fibrillation.
To assess the effects of CRT + CP on ventricular rate, left ventricular performance, and mechanical synchrony.

Main Methods:

The study involved inducing AF in six dogs.
Pacing modalities included rapid right ventricular pacing, rapid CRT, CRT + CP, and CRT with vagal stimulation (CRT-VS).
Left ventricular pressure, cardiac output, and 2D strain echocardiography were used for analysis.

Main Results:

CRT + CP significantly reduced ventricular response rate and increased left ventricular systolic pressure and cardiac output compared to CRT alone.
CRT + CP improved left ventricular ejection fraction, peak global circumferential strain, and diastolic filling time compared to CRT-VS.
The CRT + CP strategy did not result in increased mechanical dyssynchrony.

Conclusions:

CRT + CP is an effective strategy for reducing ventricular rate during AF.
This combined therapy enhances both systolic and diastolic cardiac performance.
CRT + CP offers benefits beyond simple rate control without inducing harmful dyssynchrony.