Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Hyde, ER; Behar, JM; Claridge, S; Jackson, T; Lee, AW; Remme, EW; Sohal, M; Plank, G; Razavi, R; Rinaldi, CA; Niederer, SA.
Beneficial Effect on Cardiac Resynchronization From Left Ventricular Endocardial Pacing Is Mediated by Early Access to High Conduction Velocity Tissue: Electrophysiological Simulation Study.
Circ Arrhythm Electrophysiol. 2015; 8(5):1164-1172
Doi: 10.1161/CIRCEP.115.002677
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- Co-Autor*innen der Med Uni Graz
- Plank Gernot
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- Abstract:
- 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. 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×(LVLATep-LVLATen)/LVLATep and %dT=100×(TLATep-TLATen)/TLATep, 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. 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 well as concentric remodeling, are more likely to benefit from reduced ATs and increased synchrony arising from endocardial pacing. © 2015 American Heart Association, Inc.
- Find related publications in this database (using NLM MeSH Indexing)
- Animals -
- Anisotropy -
- Cardiac Resynchronization Therapy - methods
- Dogs -
- Electrophysiologic Techniques, Cardiac -
- Endocardium - physiopathology
- Heart Failure - physiopathology
- Heart Failure - therapy
- Heart Ventricles - physiopathology
- Hemodynamics - physiology
- Humans -
- Find related publications in this database (Keywords)
- cardiac resynchronization therapy
- electrophysiology
- electric stimulation
- heart failure
- heart ventricles