A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study

Shetty, Anoop; Sohal, Manav; Chen, Zhong; Ginks, Matthew; Bostock, Julian; Amraoui, Sana; Ryu, Kyungmoo; Rosenberg, Stuart P.; Niederer, Steven A.; Gill, Jaswinder; Carr‐White, Gerald; Razavi, Reza; Rinaldi, Christopher Aldo

doi:10.1093/europace/eut420

Cited by 82 publications

(59 citation statements)

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“…2,3,5,39,42 This article has focused on understanding the causative mechanisms of these clinical findings from a cardiac electrophysiological viewpoint. It has been argued that the benefit of LV endocardial pacing may be derived from the ability to access the optimal pacing site when the anatomy of the coronary sinus limits access to the epicardial site in the same region.…”

Section: Discussionmentioning

confidence: 99%

“…Some human studies have found limited difference in hemodynamics between endocardial and epicardial pacing, 3,4,39 in contrast to findings in canines. 6,9 This may be because of interspecies physiological differences or optimal response may be dependent on the mode of stimulus delivery because roving catheters were used in patients, whereas plunge electrodes were used in canine experiments.…”

Section: Comparison With Previous Studiesmentioning

confidence: 91%

“…Recent studies in patients that compared the mean QRSd across multiple pacing sites did not report a significant decrease in QRSd or in the time from first-to-last activation of the LV endocardial surface for ENDO-CRT relative to conventional CRT, 5,39,40 whereas a decrease in QRSd was found in human and canine cases when comparing paired transmural pacing sites. 9,41 One possible explanation for the former finding is that CRT patients tend to have a reduced ejection fraction which is associated with eccentric remodeling, and as we have shown in this article, this remodeling type is less sensitive to LV pacing strategy.…”

Section: Comparison With Previous Studiesmentioning

confidence: 95%

“…This reflects the greater availability of electric activation data under a range of pacing protocols in canine models relative to similar human measurements. There is a scarcity of human data relating to ATs with endocardial compared with epicardial pacing, and results from these few relevant studies are often conflicting.Some human studies have found limited difference in hemodynamics between endocardial and epicardial pacing, 3,4,39 in contrast to findings in canines. 6,9 This may be because of interspecies physiological differences or optimal response may be dependent on the mode of stimulus delivery because roving catheters were used in patients, whereas plunge electrodes were used in canine experiments.…”

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confidence: 91%

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Beneficial Effect on Cardiac Resynchronization From Left Ventricular Endocardial Pacing Is Mediated by Early Access to High Conduction Velocity Tissue

Hyde

Behar

Claridge

et al. 2015

Circ: Arrhythmia and Electrophysiology

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Dyssynchronous heart failure (HF) is routinely treated with cardiac resynchronization therapy (CRT). During conventional biventricular (BV) CRT, pacing is applied to the right ventricle (RV) endocardium and the left ventricle (LV) epicardium via the coronary sinus (EPI-CRT BV ). Current best practice results in 30% to 40% of CRT patients failing to display improved clinical response.1 Recent clinical 2-5 and experimental 6,7 evidence suggests that BV CRT with an endocardial pacing strategy for the LV lead (ENDO-CRT BV ) can provide an improvement in acute hemodynamic response and stroke work over EPI-CRT BV and offers a novel approach for increasing CRT response rates. However, the relative importance of cardiac physiology or better access to optimal pacing sites in causing this improved outcome remains controversial. Identifying and understanding physiological mechanisms behind improved ENDO-CRT BV response are crucial for optimizing clinical procedures and identifying patients who will receive the maximal benefit from this therapy.In acute left bundle branch block (LBBB) canine studies, ENDO-CRT BV improved the systolic LV function over conventional EPI-CRT BV .6 Electric activation times (ATs) as measured by contact mapping were decreased with ENDO-CRT BV © 2015 American Heart Association, Inc. Original Article Circ Arrhythm Electrophysiol Background-Cardiac resynchronization therapy (CRT) delivered via left ventricular (LV) endocardial pacing (ENDO-CRT) is associated with improved acute hemodynamic response compared with LV epicardial pacing (EPI-CRT).The role of cardiac anatomy and physiology in this improved response remains controversial. We used computational electrophysiological models to quantify the role of cardiac geometry, tissue anisotropy, and the presence of fast endocardial conduction on myocardial activation during ENDO-CRT and EPI-CRT. Methods and Results-Cardiac activation was simulated using the monodomain tissue excitation model in 2-dimensional (2D) canine and human and 3D canine biventricular models. The latest activation times (LATs) for LV endocardial and biventricular epicardial tissue were calculated (LVLAT and TLAT), as well the percentage decrease in LATs for endocardial (en) versus epicardial (ep) LV pacing (defined as %dLV=100×(LVLAT ep −LVLAT en )/LVLAT ep and %dT=100×(TLAT ep −TLAT en )/TLAT ep , respectively). Normal canine cardiac anatomy is responsible for %dLV and %dT values of 7.4% and 5.5%, respectively. Concentric and eccentric remodeled anatomies resulted in %dT values of 15.6% and 1.3%, respectively. The 3D biventricular-paced canine model resulted in %dLV and %dT values of −7.1% and 1.5%, in contrast to the experimental observations of 16% and 11%, respectively. Adding fast endocardial conduction to this model altered %dLV and %dT to 13.1% and 10.1%, respectively. Conclusions-Our results provide a physiological explanation for improved response to ENDO-CRT. We predict that patients with viable fast-conducting endocardial tissue or distal Purkinje network or both, as we...

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Section: Discussionmentioning

confidence: 99%

Section: Comparison With Previous Studiesmentioning

confidence: 91%

Section: Comparison With Previous Studiesmentioning

confidence: 95%

mentioning

confidence: 91%

See 2 more Smart Citations

Beneficial Effect on Cardiac Resynchronization From Left Ventricular Endocardial Pacing Is Mediated by Early Access to High Conduction Velocity Tissue

Hyde

Behar

Claridge

et al. 2015

Circ: Arrhythmia and Electrophysiology

Self Cite

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“…There is evidence from both animal and clinical studies that, compared to epicardial stimulation, LV endocardial stimulation by activating the ventricular myocardium in a more physiological fashion may deliver superior electrical and hemodynamic properties and be less likely to cause phrenic nerve stimulation 2, 3, 4, 5. For a select group of patients who have failed conventional CRT delivered via an epicardial LV lead, this approach may be of value.…”

Section: Discussionmentioning

confidence: 99%

Splinting and mechanical disruption of the mitral valve apparatus by an endocardial left ventricular lead while delivering cardiac resynchronization therapy

Behar

Ranjan

Sporton

et al. 2018

Clinical Case Reports

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Endocardial left ventricular pacing

Elliott

Mehta

Sidhu

et al. 2021

Herz

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Cardiac resynchronization therapy (CRT) is an effective treatment for dyssynchronous heart failure; however, 30–50% of patients fail to improve after implant. Endocardial left ventricular (LV) pacing is an alternative therapy for patients who do not respond to conventional CRT or in whom placement of a lead via the coronary sinus is not possible. It enables pacing at a wide variety of sites, without restrictions due to coronary sinus anatomy, and there is evidence of superior electrical resynchronization and hemodynamic response compared with conventional epicardial CRT. In this article, we discuss the potential advantages and disadvantages of endocardial LV pacing compared with conventional CRT, review the evidence for the delivery of endocardial LV pacing using both lead-based and leadless systems, and explore possible future directions of this novel technology.

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A comparison of left ventricular endocardial, multisite, and multipolar epicardial cardiac resynchronization: an acute haemodynamic and electroanatomical study

Abstract: Biventricular endocardial pacing and not MSP was superior to conventional CRT, but was highly site specific. Within individuals, however, different methods of stimulation are optimal and may need to be tailored to the underlying substrate.

Cited by 82 publications

References 22 publications

Beneficial Effect on Cardiac Resynchronization From Left Ventricular Endocardial Pacing Is Mediated by Early Access to High Conduction Velocity Tissue

Beneficial Effect on Cardiac Resynchronization From Left Ventricular Endocardial Pacing Is Mediated by Early Access to High Conduction Velocity Tissue

Splinting and mechanical disruption of the mitral valve apparatus by an endocardial left ventricular lead while delivering cardiac resynchronization therapy

Endocardial left ventricular pacing

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