Key result
Atrioventricular block and left bundle branch block in canine hearts lead to complex structural, electrical, and mechanical remodeling, with electrical remodeling lacking reversibility upon pacing.
Highlights the complex time courses and potential irreversibility of electrical remodeling in canine models of AV-block and LBBB.
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Potential irreversibility of electrical remodeling cautions against assuming full pacing reversibility; leaves open translation from canine models to human conduction disease.
Long lasting alterations in loading conditions lead to adaptations in structural remodeling (hypertrophy, changes in the size of the cardiac muscle and the cavity and its connective tissue content), mechanical remodeling (abnormal contraction and relaxation of the heart) and electrical remodeling (increased sensitivity to arrhythmias). In canine hearts with atrioventricular (AV)-block (bradycardia-induced volume overload) the three kinds of remodeling follow different time courses, emphasizing the complexity of myocardial adaptation processes. This is further emphasized by the lack of reversibility of electrical remodeling when normalizing volume load by pacing at physiological heart rate. Evidence is increasing that long lasting asynchronous activation (ventricular pacing, left bundle branch block) leads to eccentric hypertrophy with regional differences in structural, electrical and mechanical remodeling.
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Maaike Peschar (2004) conducted a review in Atrioventricular block and left bundle branch block. Atrioventricular block and left bundle branch block was evaluated on Structural, electrical and mechanical remodeling. Atrioventricular block and left bundle branch block in canine hearts lead to complex structural, electrical, and mechanical remodeling, with electrical remodeling lacking reversibility upon pacing.
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