Effects of Varying Pacemaker Sites on Left Ventricular Performance

Miyazawa, Keiji; Shirato, Kunio; Haneda, Takashi; Honna, Takao; Arai, Toru; Nakajima, Toshiyuki

doi:10.1620/tjem.120.301

Cited by 14 publications

(7 citation statements)

References 17 publications

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“…In the present study, however, RVO and LVA pacing caused a similar diminution of stroke volume and end-diastolic volume. This finding coincides with the previous hemodynamic studies, which demonstrated a uniform diminution of cardiac output and systemic blood pressure with ventricular pacing but no significant difference by changing the site of ventricular pacing (Tsagaris et al 1970;Gibson et al 1971;Miyazawa et al 1976). With LVA pacing, systolic bulging of the apex was associated with a vigorous contraction of the posterior wall of the left ventricle.…”

Section: Discussionsupporting

confidence: 92%

“…Our previous studies (Miyazawa et al 1976(Miyazawa et al , 1977a showed that ventricular pacing from various sites caused a diminution of cardiac output and systemic bood pressure as compared with right atrial pacing, and there were no significant differences in these hemodynamic parameters by changing the site of ventricular pacing. However, little information is available concerning the influence of asynchronous activation on the contraction patterns of the left ventricle and the relation with the cardiac pumping action (Ueda et al 1968;Herman and Gorlin 1969;Eber et al 1974).…”

mentioning

confidence: 97%

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Dynamic Geometry of the Left Ventricle during Ventricular Pacing: Correlation with Cardiac Pumping Action

Miyazawa

Honna

Haneda

et al. 1978

Tohoku J. Exp. Med.

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-In five anesthetized open chest dogs, contraction patterns of the left ventricle induced by ventricular pacing were analyzed using cineangiocardiography.Left ventriculography was performed with dogs in the right anterior oblique position. The right atrial appendage (RA) and two ventricular sites (RVO: outflow tract of the right ventricle and LVA: apex of the left ventricle) were stimulated electri cally at a rate of 150 per min. Contraction patterns and cardiodynamics in response to ventricular pacing were compared with those to RA pacing, which represents a normal sequence and extent of ventricular contraction.RVO pacing resulted in asyneresis of anterior wall and normal contraction of posterior wall, while LVA pacing produced a systolic expansion of the apex associated with enhanced contraction of the posterior wall. Ventricular pacing uniformly caused decreases in left ventricular end-diastolic volume (LVEDV), stroke volume (SV) and ejection fraction (EF), with relatively constant left ventricular end-systolic volume (LVESV). Blood pressure was significantly decreased with ventricular pacing. There were only minor differences of these parameters between RVO and LVA pacing.It was considered that a diminution of SV and EF during ventricular pacing resulted from the asynchronous contraction of the ventricle which was not related to decreased myocardial contractility. cineangiocar diography; ventricular pacing; ventricular asynchrony; cardiac performance; pacemaker siteIt has been well known that ectopic ventricular beats are associated with asynchronous contraction of the left ventricle (Herman et al. 1967). Our previous studies (Miyazawa et al. 1976(Miyazawa et al. , 1977a showed that ventricular pacing from various sites caused a diminution of cardiac output and systemic bood pressure as compared with right atrial pacing, and there were no significant differences in these hemodynamic parameters by changing the site of ventricular pacing. However, little information is available concerning the influence of asynchronous activation on the contraction patterns of the left ventricle and the relation with the cardiac pumping action (Ueda et al. 1968;Herman and Gorlin 1969;Eber et al. 1974). In this regard, the present study was undertaken to describe the

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Section: Discussionsupporting

confidence: 92%

mentioning

confidence: 97%

Dynamic Geometry of the Left Ventricle during Ventricular Pacing: Correlation with Cardiac Pumping Action

Miyazawa

Honna

Haneda

et al. 1978

Tohoku J. Exp. Med.

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“…As reported previously, cardiac performance was lower during ventricular pacing when compared with RA pacing, and there were no significant differences by changing the ventricular pacing site (Miyazawa et al 1976(Miyazawa et al , 1977(Miyazawa et al , 1978. The present study demonstrated that the biphasic and diminished contraction of the septal or lateral wall was related to the monophasic and increased contraction of the lateral or septal wall, respectively.…”

Section: Discussionsupporting

confidence: 83%

Cineventriculographic Analysis of the Ventricular Septal Motion during Stimulation of Various Pacemaker Site

Miyazawa

Honna

Haneda

et al. 1978

Tohoku J. Exp. Med.

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By means of cineventriculography, contraction pattern of the ventricular septum was studied during electrical stimulation of the right atrium (RA), outflow tract (RVO) and apex (RVA) of the right ventricle and apex (LVA) and lateral wall (LVL) of the left ventricle.RA pacing produced a monophasic shortening of the septal hemiaxes after initial lengthening for about 40 msec from R wave of ECG. In contrast, ventricular stimulation near the septum (i.e. RVO, RVA and LVA) resulted in a biphasic and decreased contraction of the septal wall, in which an early preejection shortening was followed by a brief lengthening and second shortening.LVL pacing showed a monophasic and increased contrac tion of the septal wall. The biphasic motion of the septal wall was likely to be related to the abnormal mechanical contraction caused by the abnormal conduction sequence of ventricular depolarization.On the other hand, the lateral wall demonstrated a biphasic and decreased contraction during LVL pacing, and a monophasic and increased contraction during RVO, RVA and LVA pacing. Thus, the biphasic and diminished contraction at the site of electrical stimulation was compensated by the monophasic and forceful contraction of the contralateral wall. It is considered that the ventricular septum plays an important functional role in regulation of cardiac performance. ventricular septum; left ventriculogram; ventricular asynchrony; cineradiography; pacemaker siteIt has been known that cardiac output and systemic blood pressure during ventricular pacing are lower than those observed during right atrial pacing at the same rate.Our previous study, using two straingauge arches attached to the apical and lateral walls of the left ventricle, demonstrated that the decrease in cardiac performance during ventricular pacing was related to the severity of asynchrony rather than the change in regional myocardial tension (Miyazawa et al. 1977).The interventricular septum appears anatomically to be a part of the left ventricle, but relatively little is known about the functional contribution of the septum to the left ventricle.From this standpoint, the cineventriculographic and cineradiographic studies were designed to analyze the dynamic behavior of the septum to gether with that of contralateral free wall during atrial and ventricular rhythm

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“…Several studies, using single chamber pacing, suggested little or no influence of the site of pacing on ventricular performance. 50,83,[93][94][95][96][97] In contrast, other studies using single chamber pacing 28,[98][99][100][101][102] and virtually all studies using AV sequential pacing 29,34,44,45,57,63,103,104 showed a significant influence of the site of pacing on hemodynamic performance.…”

Section: Influence Of Abnormal Electrical Activation Of the Ventriclesmentioning

confidence: 99%

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

Prinzen

Peschar

2002

Pacing Clinical Electrophis

253

195

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The main goal of this article was to review animal experimental work on the effect of asynchronous activation on ventricular pump function. During normal sinus rhythm and atrial pacing, the Purkinje system contributes significantly to the rapid electrical activation of the ventricles. In contrast, during ventricular pacing the impulse is almost exclusively conducted through the normal myocardium. As a consequence, electrical activation of the ventricles becomes asynchronous and has an abnormal sequence. The abnormal impulse conduction causes considerable disturbances to occur in regional systolic fiber shortening, mechanical work, blood flow, and oxygen consumption; low values occurring in early activated regions and values above normal being present in late activated regions. Many animal studies have now shown that the abnormal electrical activation, induced by ventricular pacing, leads to a depression of systolic and diastolic LV function. Pacing at the right ventricular apex (the conventional pacing site) reduces LV function more than pacing at the high ventricular septum or at LV sites. In canine hearts with experimental LBBB, LV pacing significantly improves LV pump function. Differences in LV pump function between (combinations of) pacing sites are poorly correlated with QRS duration. Therefore, the cause of the depression of LV function during abnormal electrical activation appears to be a combination of the asynchrony and the sequence of activation. These experimental findings justify continuing attention for optimizing the site(s) of ventricular pacing in patients with normal and abnormal ventricular impulse conduction.

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Effects of Varying Pacemaker Sites on Left Ventricular Performance

Cited by 14 publications

References 17 publications

Dynamic Geometry of the Left Ventricle during Ventricular Pacing: Correlation with Cardiac Pumping Action

Dynamic Geometry of the Left Ventricle during Ventricular Pacing: Correlation with Cardiac Pumping Action

Cineventriculographic Analysis of the Ventricular Septal Motion during Stimulation of Various Pacemaker Site

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

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