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Original Articles

Left Ventricular Endocardial Pacing Improves Resynchronization Therapy in Canine Left Bundle-Branch Hearts

Caroline van Deursen, BSc; Irene E. van Geldorp, MD; Leonard M. Rademakers, MD; Arne van Hunnik, BSc; Marion Kuiper, BSc; Catherine Klersy, MD, PhD; Angelo Auricchio, MD, PhD and Frits W. Prinzen, PhD

From the Departments of Physiology and Cardiothoracic Surgery (C.v.D., I.E.v.G., L.M.R., A.H., M.K., F.W.P.), Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands; Biometry and Clinical Epidemiology (C.K.), Research Department, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy; and Fondazione Cardiocentro Ticino (A.A.), Lugano, Switzerland.

Correspondence to Frits W. Prinzen, PhD, Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD Maastricht, The Netherlands. E-mail frits.prinzen{at}fys.unimaas.nl

Received December 19, 2008; accepted July 8, 2009.

Background— We investigated the benefits of the more physiological activation achieved by left ventricular (LV) endocardial pacing (ENDO) as compared with conventional epicardial (EPI) LV pacing in cardiac resynchronization therapy.

Methods and Results— In 8 anesthetized dogs with experimental left bundle-branch block, pacing leads were positioned in the right atrium, right ventricle, and at 8 paired (EPI and ENDO) LV sites. Systolic LV pump function was assessed as LVdP/dtmax and stroke work and diastolic function as LVdP/dtmin. Electrical activation and dispersion of repolarization were determined from 122 epicardial and endocardial electrodes and from analysis of the surface ECG. Overall, ENDO-biventricular (BiV) pacing more than doubled the degree of electrical resynchronization and increased the benefit on LVdP/dtmax and stroke work by 90% and 50%, respectively, as compared with EPI-BiV pacing. During single-site LV pacing, the range of AV intervals with a >10% increase in LV resynchronization (79±31 versus 32±24 ms, P<0.05) and LVdP/dtmax (92±29 versus 63±39 ms) was significantly longer for ENDO than for EPI pacing. EPI-BiV but not ENDO-BiV pacing created a significant (40±21 ms) transmural dispersion of repolarization.

Conclusions— Data from this acute animal study indicate that the use of an endocardial LV pacing electrode may increase the efficacy of resynchronization therapy as compared with conventional epicardial resynchronization therapy.

Key Words: bundle-branch block • electrophysiology • hemodynamics • pacing

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CLINICAL PERSPECTIVE