Key result
LV septal or apical pacing preserves LV function best compared to conventional RV apex pacing.
Why the study?
The optimal left ventricular pacing site for maintaining pump function by mimicking physiological electrical conduction was uncertain.
Does pacing at the left ventricular septum or apex maintain better left ventricular pump function compared to right ventricular apex pacing in canine hearts?
Does pacing at the left ventricular septum or apex maintain better left ventricular pump function compared to right ventricular apex pacing in canine hearts?
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“The history of LVSP started in 2003, when Peschar et al showed, in normal canine hearts, that LVSP provided hemodynamics (pressure, stroke volume, pressure-volume loops) similar to normal sinus rhythm.”
Pacing at the left ventricular septum or apex preserves physiological electrical propagation and left ventricular pump function better than traditional right ventricular apical pacing in a canine model.
OBJECTIVES: The goal of this study was to test the hypothesis that left ventricular (LV) pump function is optimal when pacing is performed at the LV near the sites where the impulses exit the Purkinje system. BACKGROUND: Pacing at the conventional site, the right ventricular (RV) apex, adversely affects hemodynamics. During normal sinus rhythm (SR), electrical activation of the working myocardium starts at the LV septal endocardium and spreads from apex to base. METHODS: Experiments were conducted in anesthetized open-chest dogs with normal ventricular conduction to investigate hemodynamic effects of pacing at various epicardial LV sites, the RV apex, and combinations of these sites (n = 11) and of RV and LV septal pacing (n = 8). The LV septal endocardium was reached via the RV by puncturing through the septum with a barbed electrode. Left ventricular systolic (LVdP/dtpos and stroke work) and diastolic (LVdP/dtneg and Tau) function were assessed using pressure-volume relations (conductance catheter technique). RESULTS: Left ventricular systolic and diastolic function were highly dependent on the site of pacing, but not on QRS duration. Left ventricular function was maintained at SR level during LV septal, LV apex, and multisite pacing, was moderately depressed during pacing at epicardial LV free wall sites, and was most severely depressed during RV apex pacing. On average, RV septal pacing did not improve LV function, compared with RV apex pacing, but in each experiment one (variable) RV pacing site was found, which only moderately reduced LV function. CONCLUSIONS: During ventricular pacing, LV pump function is maintained best (i.e., at SR level) when pacing at the LV septum or LV apex, potentially because pacing from these sites creates a physiological propagation of electrical conduction.
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Peschar et al. (2003) studied Normal ventricular conduction (canine model) (n=19). Left ventricular septal and apex pacing vs. Right ventricular apex pacing was evaluated on Left ventricular systolic and diastolic function (assessed via LVdP/dtpos, stroke work, LVdP/dtneg, and Tau). Left ventricular pump function is maintained best at sinus rhythm levels during pacing at the LV septum or LV apex, whereas it is most severely depressed during conventional RV apex pacing.
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