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Effects of single-site and multi-site ventricular pacing on left and right ventricular mechanics and synchrony: is there an optimal pacing sequence?

Nishijima, Yoshinori
http://rave.ohiolink.edu/etdc/view?acc_num=osu1126717344

Abstract Details

2005, Doctor of Philosophy, Ohio State University, Veterinary Biosciences.
Cardiac resynchronization therapy (CRT) is a new treatment for heart failure by correcting electrical and mechanical ventricular asynchrony. Although this technique is promising, the type of ventricular pacing, the precise pacing locations, and the interventricular pacing intervals (VV delay) which yield the optimal clinical response is unknown. The objective of this study was to determine the optimal pacing site(s) and VV delay in healthy canine hearts. For each of 6 dogs, the right atrium was paced at 120 bpm. For single-site ventricular pacing (80 ms atrioventricular delay), one of two right ventricular (RV) sites (apex and base) or one of five left ventricular (LV) sites (anterior and posterior base, anterior and posterior mid free-wall, and apex) was paced. For multi-site pacing, LV pacing followed RV pacing with a VV delay of 4, 8, 16, or 32 ms. LV pacing was initiated by stimulating either one of five pacing sites or all five pacing sites simultaneously. For each pacing protocol, optimal systolic function (e.g., maximal ventricular pressures, dP/dtmax, d2P/dt2max) and optimal ventricular synchrony (e.g., shortest QRS duration and shortest time difference between peak dLVP/dtmax and dRVP/dtmax) were determined. ANOVA with Tukey’s post-test was used for statistical analysis. Ventricular synchrony was optimized for single-site pacing at the RV apex and for multi-site with RV apex, short VV delay, and entire LV pacing. LV function was optimized with single-site pacing at the LV apex, while the RV apex, mid-LV, and shortest VV delay combination optimized LV function for multi-site pacing. RV function was optimized with single-site pacing at the RV base and with the RV base, mid-posterior LV, and longest VV delay combination for multi-site pacing. The effect of different VV delays on LV function was small, while a longer delay produced larger benefits to RV function. The results of this study provide insight into optimal locations, pairs and delays in pacing healthy ventricles and provide a starting point for evaluating optimal settings in disease. Specifically, the combination of RV base and mid-posterior LV pacing with a 32 ms delay may optimize biventricular function and should be evaluated in the failing heart.
Robert Hamlin (Advisor)
156 p.
cardiac pacing; ventricular function

Recommended Citations

Citations

  • Nishijima, Y. (2005). Effects of single-site and multi-site ventricular pacing on left and right ventricular mechanics and synchrony: is there an optimal pacing sequence? [Doctoral dissertation, Ohio State University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=osu1126717344

    APA Style (7th edition)

  • Nishijima, Yoshinori. Effects of single-site and multi-site ventricular pacing on left and right ventricular mechanics and synchrony: is there an optimal pacing sequence? 2005. Ohio State University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=osu1126717344.

    MLA Style (8th edition)

  • Nishijima, Yoshinori. "Effects of single-site and multi-site ventricular pacing on left and right ventricular mechanics and synchrony: is there an optimal pacing sequence?" Doctoral dissertation, Ohio State University, 2005. http://rave.ohiolink.edu/etdc/view?acc_num=osu1126717344

    Chicago Manual of Style (17th edition)

osu1126717344
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This open access ETD is published by The Ohio State University and OhioLINK.