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Related Experiment Videos

Differing effects of right ventricular pacing and left bundle branch block on left ventricular function

H B Xiao1, S J Brecker, D G Gibson

  • 1Cardiac Department, Royal Brompton National Heart and Lung Hospital, London.

British Heart Journal
|February 1, 1993
PubMed
Summary

Right ventricular pacing activates the left ventricle faster than left bundle branch block, leading to significant differences in electromechanical delay and wall motion. These findings challenge the use of right ventricular pacing as a model for left bundle branch block in humans.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Imaging

Background:

  • Right ventricular pacing (RVP) and left bundle branch block (LBBB) affect left ventricular (LV) activation patterns.
  • Understanding these differences is crucial for managing heart failure and optimizing pacing strategies.

Purpose of the Study:

  • To compare the distinct effects of RVP and classic LBBB on left ventricular function.
  • To evaluate differences in electromechanical delay and ventricular wall motion between RVP and LBBB.

Main Methods:

  • A retrospective and prospective study involving 48 patients.
  • Utilized electrocardiography and various echocardiographic techniques (M-mode, cross-sectional, Doppler).
  • Patients were divided into two groups: 24 with VVI pacemakers and 24 with LBBB.

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Main Results:

  • While overall systolic function was similar, RVP showed significantly longer QRS duration and electromechanical delay compared to LBBB.
  • Contraction and relaxation times were shorter in RVP, with distinct patterns of ventricular septal contraction and posterior wall thickening.
  • Incoordinate wall motion was significantly greater in LBBB patients.

Conclusions:

  • Left ventricular activation appears more rapid with RVP than LBBB, even in patients with pre-existing LBBB.
  • Striking differences exist in electromechanical delay, contraction/relaxation times, and incoordinate wall motion.
  • The utility of RVP as a human model for LBBB requires re-evaluation.