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Related Experiment Video

Updated: May 20, 2026

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Biventricular pacing improves left ventricular function by 2-D strain in right ventricular failure.

Casey Wong1, Santos E Cabreriza, Maria Nugent

  • 1Weill Cornell Medical College, New York, New York, USA.

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|July 4, 2012
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Summary

Optimized biventricular pacing (BiVP) improves left ventricular (LV) synchrony and regional function during acute right ventricular pressure overload (RVPO). Right ventricular pacing (RVP) also restores synchrony, unlike LV pacing (LVP).

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Area of Science:

  • Cardiovascular Physiology
  • Echocardiography
  • Cardiac Pacing

Background:

  • Acute right ventricular pressure overload (RVPO) can impair left ventricular (LV) function and synchrony.
  • The effectiveness of biventricular pacing (BiVP) in improving LV strain during RVPO requires investigation.

Purpose of the Study:

  • To test the hypothesis that regional LV strain improves with optimized BiVP during acute RVPO.
  • To compare the effects of BiVP, right ventricular pacing (RVP), and LV pacing (LVP) on LV synchrony and function.

Main Methods:

  • RVPO and complete heart block were induced in anesthetized pigs.
  • BiVP was optimized to maximize cardiac output by adjusting atrioventricular and interventricular delays.
  • Speckle-tracking echocardiography assessed LV segmental strain (radial) and time to peak (TTP) strain in anterior septal (AS) and posterior wall segments.

Main Results:

  • Optimized BiVP (RV first) resulted in higher cardiac output compared to LVP.
  • LVP significantly prolonged AS TTP strain compared to BiVP and RVP, indicating impaired intraventricular synchrony.
  • Both BiVP and RVP restored intraventricular synchrony, with significant increases in posterior wall strain during BiVP and RVP, unlike LVP.

Conclusions:

  • BiVP and RVP effectively restore LV intraventricular synchrony and enhance regional function during RVPO, outperforming LVP.
  • RV pre-excitation via RVP or BiVP unloads the RV, shortens AS contraction duration, and promotes synchrony and free wall contraction.