title: Comparative electromechanical and hemodynamic effects of left ventricular and biventricular pacing in dyssynchronous heart failure: electrical resynchronization versus left-right ventricular interaction.
abstract: OBJECTIVE
  The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP).
  
  
  BACKGROUND
  It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure.
  
  
  METHODS
  Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dtmax]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique.
  
  
  RESULTS
  LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone.
  
  
  CONCLUSIONS
  Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands. Electronic address: joost.lumens@maastrichtuniversity.nl.
authors.forename: Joost
authors.initials: J
authors.lastname: Lumens
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Ploux
authors.affiliation: Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Strik
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Hubert
authors.initials: H
authors.lastname: Cochet
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Derval
authors.affiliation: CardioInsight Technologies, Cleveland, Ohio.
authors.forename: Maria
authors.initials: M
authors.lastname: Strom
authors.affiliation: CardioInsight Technologies, Cleveland, Ohio.
authors.forename: Charu
authors.initials: C
authors.lastname: Ramanathan
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Ritter
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Haïssaguerre
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Jaïs
authors.affiliation: Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Arts
authors.affiliation: Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
authors.forename: Tammo
authors.initials: T
authors.lastname: Delhaas
authors.affiliation: Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Bordachar
mesh_terms: D000818:Animals; D058406:Cardiac Resynchronization Therapy / Q000379:methods* / Q000592:standards; D004285:Dogs; D004562:Electrocardiography / Q000379:methods* / Q000592:standards; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D013045:Species Specificity; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: % change in maximal rate of left ventricular pressure rise; % change in maximal rate of right ventricular pressure rise; ANOVA; AT(TOT); AV; BiVP; CRT; ECM; HF; LBBB; LV; LVP; LVdP/dt(max); RV; RVdP/dt(max); analysis of variance; atrioventricular; biventricular pacing; cardiac resynchronization therapy; dyssynchrony; electrocardiographic mapping; electrophysiology mapping; heart failure; left bundle branch block; left ventricle/ventricular; left ventricular pacing; myocardial work; right ventricle/ventricular; total ventricular activation time; ventricular interaction