HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): George Berberian Henry M. Spotnitz Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Berberian, G. Articles by Spotnitz, H. M. Search for Related Content PubMed Articles by Berberian, G. Articles by Spotnitz, H. M.

J Thorac Cardiovasc Surg 2007;134:574-578
© 2007 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Left ventricular pacing site and timing optimization during biventricular pacing using a multielectrode patch in pigs

^a Departments of Surgery,
^b Biomedical Engineering,
^c Pediatrics,
^d Biostatistics, Columbia University, College of Physicians and Surgeons, New York, NY

Received for publication September 21, 2006; revisions received March 11, 2007; accepted for publication April 25, 2007.

^_* Address for reprints: Henry M. Spotnitz, MD, Department of Surgery, Columbia College of Physicians and Surgeons, 622 West 168th St, PH 14-103, New York, NY 10032 (Email: hms2{at}columbia.edu).

Objectives: Biventricular pacing is important therapy for congestive heart failure, reversing left ventricular dysfunction in dilated cardiomyopathy. Although left ventricular lead location and right ventricular–left ventricular delay are believed to be critical in biventricular pacing, there is no established technique for optimizing pacing site and timing.

Methods: After median sternotomy in 8 anesthetized pigs, an ultrasonic flow probe was placed on the ascending aorta to measure cardiac output, and pressure catheters were inserted into both ventricles. Temporary bipolar epicardial pacing leads were attached to the right atrium and anterior right ventricle. A patch with 5 bipolar electrodes was placed behind the left ventricle. A temporary bipolar lead was also placed on the left ventricular apex. Complete heart block was established by ethanol ablation. Right ventricular pressure overload was induced by snaring the pulmonary artery until right ventricular systolic pressure doubled. Dual-chamber mode biventricular pacing was instituted at 9 right ventricular–left ventricular delays, +80 ms to –80 ms in 20 ms increments, and 6 left ventricular sites. Data from the 54 combinations of these variables were acquired in a randomized fashion. Mixed model technology was used for statistical analysis.

Results: Qualitatively, two unique site/timing pairs were optimal. Statistically, pacing the obtuse margin at a right ventricular–left ventricular delay of +60 ms (mean cardiac output = 1.80 L/min) and the inferolateral wall at a right ventricular–left ventricular delay of –20 ms (mean cardiac output = 1.79 L/min) was superior to all other site/timing combinations (mean cardiac output = 1.71 L/min; P = .006).

Conclusions: Left ventricular pacing site and right ventricular–left ventricular delay can be optimized with a multielectrode patch and randomized data collection. This technique can be used further in clinical studies.

This article has been cited by other articles:

				T. A. Quinn, S. E. Cabreriza, M. E. Richmond, A. D. Weinberg, J. W. Holmes, and H. M. Spotnitz Simultaneous variation of ventricular pacing site and timing with biventricular pacing in acute ventricular failure improves function by interventricular assist Am J Physiol Heart Circ Physiol, December 1, 2009; 297(6): H2220 - H2226. [Abstract] [Full Text] [PDF]