Electro-energetics of Biventricular, Septal and Conduction System Pacing

F.W. Prinzen*, J. Lumens, J. Duchenn, K. Vernooy

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.
Original languageEnglish
Pages (from-to)250-257
Number of pages8
JournalArrhythmia & Electrophysiology Review
Volume10
Issue number4
DOIs
Publication statusPublished - 1 Dec 2021

Keywords

  • Myocardial work
  • efficiency
  • biventricular pacing
  • septal pacing
  • conduction system pacing
  • CARDIAC RESYNCHRONIZATION THERAPY
  • BUNDLE-BRANCH BLOCK
  • MYOCARDIAL OXYGEN-CONSUMPTION
  • LEFT-VENTRICULAR WORK
  • DILATED CARDIOMYOPATHY
  • HIS-BUNDLE
  • BLOOD-FLOW
  • MECHANICAL ACTIVATION
  • HEART-FAILURE
  • FIBER STRAIN

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