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October 8, 2011AJP Heart and Circulatory Physiology

Mechanism of prolonged electromechanical delay in late activated myocardium during left bundle branch block

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Population

Experimental LBBB dog model, patients with biventricular pacing devices, in vitro papillary muscle study…

Comparison

Assessment of pressures, myocardial deformation… vs Septum versus lateral wall

Design

Preclinical

Key result

During left bundle branch block, electromechanical delay was prolonged in the late-activated lateral wall compared to the septum (39 vs 11 ms, P=0.002) due to higher dP/dt at the time of activation.

Authors

KRKristoffer RussellOSOtto A. SmisethOGOla Gjesdal

Discussion

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Overview

Prolonged EMD may contribute to LBBB inefficiency; leaves open whether targeting it improves CRT response.

Structured PICO

P
Population
Experimental and clinical study including 7 dogs, 9 patients with biventricular pacing devices, and 6 in vitro papillary muscles to assess electromechanical delay in LBBB.
E
Exposure
Assessment of pressures, myocardial deformation, and regional electrical activation (REA) during LBBB
C
Comparator
Septum versus lateral wall
O
Outcome
Electromechanical delay (EMD) and its relationship to dP/dt at the time of regional electrical activationsurrogate

Main Result

Absolute Event Rate: 39% vs 11%

p-value: p=0.002

Prolonged electromechanical delay in late-activated myocardium during LBBB is caused by a higher dP/dt at the time of activation, suggesting that LV contractility modifies mechanical dyssynchrony.

Cite This Study

Russell et al. (2011) studied Left bundle branch block (n=22). Late-activated left ventricular lateral wall vs. Septum was evaluated on Electromechanical delay (EMD) (p=0.002). During left bundle branch block, electromechanical delay was prolonged in the late-activated lateral wall compared to the septum (39 vs 11 ms, P=0.002) due to higher dP/dt at the time of activation.

synapsesocial.com/papers/6a61ddedf5a6cede3a89af54https://doi.org/10.1152/ajpheart.00644.2011
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