Comparison between endocardial and epicardial cardiac resynchronization in an experimental model of non-ischaemic cardiomyopathy
Por:
Amoros-Figueras, G, Jorge, E, Raga, S, Alonso-Martin, C, Rodriguez-Font, E, Bazan, V, Vinolas, X, Cinca, J, Guerra, JM
Publicada:
1 jul 2018
Resumen:
Aims Pacing from the left ventricular (LV) endocardium might increase the likelihood of response to cardiac resynchronization therapy. However, experimental and clinical data supporting this assumption are limited and controversial. The aim of this study was to compare the acute response of biventricular pacing from the LV epicardium and endocardium in a swine non-ischaemic cardiomyopathy (NICM) model of dyssynchrony.
Methods and results A NICM was induced in six swine by 3 weeks of rapid ventricular pacing. Biventricular stimulation was performed from 16 paired locations in the LV (8 epicardial and 8 endocardial) with two different atrioventricular (80 and 110 ms) intervals and three interventricular (0, thorn30, -30 ms) delays. The acute response of the aortic blood flow, LV and right ventricular (RV) pressures, LVdP/dt(max) and LVdP/dt(min) and QRS complex width and QT duration induced by biventricular stimulation were analysed. The haemodynamic and electrical beneficial responses to either LV endocardial or epicardial biventricular pacing were similar (DLVdP/dt(max): +7.8 +/- 2.2% ENDO vs. +7.3 +/- 1.5% EPI, and Delta QRS width: -16.8 +/- 1.3% ENDO vs. -17.1 +/- 1.9% EPI; P = ns). Pacing from LV basal regions either from the epicardium or endocardium produced better haemodynamic responses as compared with mid or apical LV regions (P < 0.05). The LV regions producing the maximum QRS complex shortening did not correspond to those inducing the best haemodynamic responses (EPI: r(2) = 0.013, P = ns; ENDO: r(2) = 0.002, P = ns).
Conclusion Endocardial LV pacing induced similar haemodynamic changes than pacing from the epicardium. The response to endocardial LV pacing is region dependent as observed in epicardial pacing.
Filiaciones:
Amoros-Figueras, G:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Jorge, E:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Raga, S:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Alonso-Martin, C:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Rodriguez-Font, E:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Bazan, V:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Vinolas, X:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Cinca, J:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
Guerra, JM:
Univ Autonoma Barcelona, Dept Cardiol, Hosp Santa Creu & St Pau, Inst Invest Biomed St Pau,CIBERCV, Barcelona, Spain
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