Key result
LV apical pacing maintains LVEF and twist versus lateral wall pacing in pig hearts.
Why the study?
Does epicardial AV pacing at the LV apical wall improve hemodynamic and deformation variables compared to pacing at the lateral wall in pigs with normal LV function?
Does epicardial AV pacing at the LV apical wall improve hemodynamic and deformation variables compared to pacing at the lateral wall in pigs with normal LV function?
In an experimental pig model with intact myocardium, AV pacing at the LV apex preserves LV function and deformation better than pacing at the lateral wall.
Answers are grounded in this paper and cite their sources.
LV apical pacing merits clinical site-selection trials; leaves open optimal epicardial pacing strategies pending human data.
Aim. To assess the effect on left ventricular (LV) function of atrioventricular (AV) and ventricular pacing at the LV apical or lateral wall and to compare the normal torsional and deformation pattern of the intact LV myocardium with those created by the aforementioned LV pacing modes and sites. Methods. Experiments were conducted in pigs (n = 21) with normal LV function to investigate the acute hemodynamic effects of epicardial AV and ventricular LV pacing at the LV apical or lateral wall. Torsional and deformation indices of LV function were assessed using speckle tracking echocardiography. Results. AV pacing at the apex revealed a significant reduction in the radial strain of the base (P < 0.03), without affecting significantly the ejection fraction and the LV torsion or twist. In contrast, AV pacing at the lateral wall produced, in addition to the reduction of the radial strain of the base (P < 0.01), significant reduction of the circumferential and the radial strain of the apex (both P < 0.01) as well as of the ejection fraction (P < 0.002) and twist (P < 0.05). Conclusions. In pig hearts with intact myocardium, LV function is maintained at sinus rhythm level when AV pacing is performed at the LV apex.
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Toumanidis et al. (2014) studied normal LV function (n=21). Atrioventricular pacing at the left ventricular apex vs. Atrioventricular pacing at the lateral wall was evaluated on Left ventricular function (ejection fraction, twist, and strain) (p=<0.002). Atrioventricular pacing at the left ventricular apex maintained LV function, whereas pacing at the lateral wall significantly reduced ejection fraction (P<0.002) and twist (P<0.05) in pig hearts.
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