Key result
LV pre-excitation maximizes LV dP/dt max but reduces RV dP/dt max by ~33%.
Why the study?
The effect of varying pacing delays on both left and right ventricular electrical dyssynchrony and contractile function in CRT was not fully understood.
Population
6 dogs with atrioventricular block
Comparison
100 combinations of atrial-LV and atrial-RV pacing delays vs RV pacing with A-RV delay of 125ms
Design
Experimental pacing protocol combined with computer simulations using the CircAdapt model
Authors
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Highlights an inherent hemodynamic trade-off during CRT optimization; leaves open whether computer.
The left and right ventricles respond in opposite manners to variations in LV or RV pre-excitation during CRT, a behavior that can be accurately captured by computer simulations to inform future optimization studies.
Willemen et al. (2019) studied Atrioventricular block (n=6). Variation of A-LV and A-RV pacing delays vs. RV-only pacing (A-RV 125 ms) was evaluated on Relative change in maximum rate of LV and RV pressure rise (dP/dt max). Pacing the left ventricle 10-50 ms before the right ventricle led to the largest increases in LV dP/dt max, whereas RV dP/dt max was highest with RV pre-excitation and decreased up to 33% with LV pre-excitation.
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