Interplay of Electrical Wavefronts as Determinant of the Response to Cardiac Resynchronization Therapy in Dyssynchronous Canine Hearts
Why the study?
Does the optimal hemodynamic effect of CRT depend on the interplay of electrical wavefronts or ventricular filling in dyssynchronous canine hearts?
Population
14 dogs with chronic left bundle-branch block (n=8) or atrioventricular (AV) block (n=6)
Comparison
Cardiac resynchronization therapy through… vs Different combinations of A-LV/A-RV pacing…
Design
Preclinical, 100 randomized combinations of A-LV/A-RV intervals
Authors
Discussion
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Implication
Favors electrical fusion over filling for CRT hemodynamics in dyssynchrony; hypothesis-generating in canines and leaves open human translation.
Structured PICO
Does the optimal hemodynamic effect of CRT depend on the interplay of electrical wavefronts or ventricular filling in dyssynchronous canine hearts?
P
Population
14 dogs with chronic left bundle-branch block (n=8) or atrioventricular (AV) block (n=6)
I
Intervention
Cardiac resynchronization therapy (CRT) through atrial, right ventricular apex, and left ventricular-basolateral pacing testing 100 randomized combinations of A-LV/A-RV intervals
C
Comparator
Different combinations of A-LV/A-RV pacing intervals
O
Outcome
Optimal hemodynamic effect (CRTopt), defined as an increase in LVdP/dtmax of ≥90% of the maximum LVdP/dtmax valuesurrogate
In a canine model, the optimal hemodynamic benefit of CRT is driven by the fusion of pacing-induced and intrinsic electrical wavefronts leading to mechanical resynchronization, rather than by optimized ventricular filling.
Cite This Study
Strik et al. (2013) studied this question.