Acute Haemodynamic and Echocardiographic Effects of Multiple Configurations of Left Ventricular Pacing Sites in Acute
I Matthaios1, A Kaladaridou1, E Skaltsiotes1
1Department of Clinical Therapeutics, Medical School, National and Kapodistrian University of Athens, "Alexandra" Hospital, Athens, Greece.
Insights
Optimizing left ventricular (LV) pacing after acute myocardial infarction (AMI) is crucial. Pacing the LV apex lateral wall and LV basal posterior wall together best preserves LV function, mimicking natural heart rhythm.
Area of Science:
- Cardiology
- Cardiac Electrophysiology
- Heart Failure Research
Background:
- Left ventricular (LV) pacing failure is common, often due to suboptimal lead placement.
- Limited data exists on how different LV pacing sites affect cardiac function in ischemic conditions.
- Acute myocardial infarction (AMI) significantly impairs LV mechanics.
Purpose of the Study:
- To evaluate the impact of various LV pacing site combinations on LV mechanics post-AMI.
- To identify the optimal LV pacing configuration for improving cardiac function after AMI.
- To provide insights for enhancing the success rates of LV pacing.
Main Methods:
- Utilized a porcine model of experimental AMI.
- Investigated multiple combinations of epicardial LV pacing sites, including LV apex lateral, LV basal posterior, and LV basal anterior walls.
- Assessed hemodynamic parameters and echocardiographic indices, including speckle tracking, to evaluate LV function.
Main Results:
- The combination of LV apex lateral wall and LV basal posterior wall pacing demonstrated the most beneficial effects on LV function post-AMI.
- This specific pacing strategy resulted in hemodynamic and torsional parameters comparable to those observed during normal sinus rhythm.
- No statistically significant differences (p>0.05) were found between this pacing combination and sinus rhythm.
Conclusions:
- In hearts experiencing AMI, pacing the LV apex lateral wall and LV basal posterior wall concurrently can effectively maintain LV function.
- This dual-site LV pacing approach offers a promising strategy to achieve near-normal cardiac function comparable to sinus rhythm.
- Findings suggest a potential optimal configuration for LV pacing in patients with ischemic cardiomyopathy.
Background:
Left ventricular (LV) pacing is unsuccessful in a significant number of patients, mainly due to sub-optimal LV pacing location. Nevertheless, data about the impact of different pacing sites on LV function in ischaemic myocardium are scarce. The purpose of this study was to investigate the effect of combinations of alternative LV pacing sites on LV mechanics after experimental acute anterior myocardial infarction (AMI), in order to define the optimal configuration.
Methods:
Atrioventricular epicardial pacing at alternative pacing sites was performed in 16 healthy pigs simultaneously, after experimental AMI. Standard right ventricular (RV) apical pacing was combined with: i) LV apex lateral wall; ii) LV basal posterior wall; iii) LV basal anterior wall, and; iv) LV basal anterior wall + LV basal posterior wall. Moreover the pacing configurations of, v) LV basal posterior wall + LV apex lateral wall; vi) LV basal posterior wall + LV basal anterior wall, and; vii) LV basal anterior wall + LV apex lateral wall were also investigated. Haemodynamic parameters, together with classic and novel echocardiographic indices were used, to evaluate the effect of each pacing combination. A speckle tracking technique using EchoPAC software was used.
Results:
After AMI, the pacing combination of LV apex lateral wall and LV basal posterior wall had the most favourable effect on LV function, leading to similar haemodynamic and torsional effects with sinus rhythm (all variables p>0.05).
Conclusions:
In pig hearts after AMI, the combination of pacing LV apex lateral wall and LV basal posterior wall managed to maintain the LV function at a level comparable to the sinus rhythm.
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