Left ventricular torsion in paced patients

Abstract

Conventional pacing from the apex of the right ventricle alters both the torsional mechanic and the synchrony of the left ventricle.

His bundle and left bundle branch pacing

“…Im "speckle tracking" bzw. im "strain imaging" kann echokardiographisch bei Stimulation im RV-Apex praktisch immer eine Desynchronisation der LV-Kontraktion gesehen und quantifiziert werden [5,6]. Die stimulationsinduzierte Desynchronisation der ventrikulären Kontraktion hat negative inotrope Effekte, steigert den myokardialen Sauerstoffverbrauch, kann eine Mitralinsuffizienz auslösen und führt zu einem ineffizienten Remodelling mit histologischen Veränderungen des Herzmuskels.…”

Measuring Twist under Conditions of Pacing

“…The degree of twist correlates with contractile state and is diminished in the presence of left ventricular dysfunction . Of importance, the degree of cardiac twist is acutely diminished by right ventricular pacing . Additionally, these indices appear to improve with cardiac resynchronization therapy (CRT) .…”

“…10 Of importance, the degree of cardiac twist is acutely diminished by right ventricular pacing. [11][12][13] Additionally, these indices appear to improve with cardiac resynchronization therapy (CRT). 14 Also of interest, a recent study suggests that an acute improvement in twist following CRT implantation may be one of the strongest predictors of late responder status as measured by more traditional measures such as follow-up ejection fraction or decrease in endsystolic volume.…”