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Mechanical Effects on Right Ventricular Function From Left Bundle Branch Block and Cardiac Resynchronization Therapy.

Petter Storsten1, John M Aalen1, Espen Boe2

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PubMed
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Left bundle branch block (LBBB) impairs right ventricular (RV) free wall function due to abnormal septal motion. Cardiac resynchronization therapy (CRT) improves RV free wall workload by correcting this dyssynchrony.

Keywords:
cardiac resynchronization therapyheart failureleft bundle branch blockmyocardial workright ventricleseptal flash

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Area of Science:

  • Cardiology
  • Echocardiography
  • Cardiac Electrophysiology

Background:

  • Right ventricular (RV) function is crucial for prognosis in patients with left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT).
  • Limited understanding exists regarding the specific impact of LBBB and CRT on RV function.

Purpose of the Study:

  • To investigate how LBBB and CRT influence RV free wall function through direct ventricular interaction.
  • To elucidate the mechanisms underlying these functional modifications.

Main Methods:

  • Speckle-tracking echocardiography assessed RV and left ventricular (LV) strain in 24 patients with LBBB before and after CRT.
  • Underlying mechanisms were explored in 16 dogs using ultrasonic dimension crystals and micromanometers.

Main Results:

  • LBBB induced early systolic shortening in the RV free wall, coinciding with abnormal septal motion, reducing myocardial work.
  • CRT mitigated abnormal septal motion, leading to increased RV free wall work by reducing inefficient shortening against low pressure.
  • Late-activated LV lateral wall contraction maintained RV systolic function by pushing the septum toward the RV.

Conclusions:

  • LBBB diminishes RV free wall workload due to abnormal septal motion and delayed LV lateral wall activation.
  • CRT enhances RV free wall workload by restoring septal and LV function, potentially explaining poor response in some RV failure patients.