Effect of pacemaker site on cardiac output and ventricular activation in dogs with complete heart block

doi:10.1016/0002-9149(64)90033-5

The American Journal of Cardiology

Volume 14, Issue 4, October 1964, Pages 494-503

https://doi.org/10.1016/0002-9149(64)90033-5 Get rights and content

Abstract

The sequence of ventricular activation was recorded in dogs with complete heart block while the heart was paced from each of 11 ventricular sites; cardiac output was determined while the heart was paced from each of 8 ventricular sites at rates of 90, 120 and 150 per minute. The following conclusions were reached:

1.
1. Each ventricular pacemaker site results in a specific pattern of ventricular activation.
2.
2. Differences of over 100 per cent in cardiac output were recorded when the heart was paced from different ventricular sites at the same pacemaker rate.
3.
3. The optimal pacemaker rate is dependent upon the ventricular site selected for the implantation of the pacemaker electrode and the condition of the cardiovascular system.
4.
4. The hemodynamic effectiveness of the left ventricular pacemaker sites is inversely related to the muscle mass activated by muscle conduction.
5.
5. The hemodynamic effectiveness of right ventricular pacemakers is dependent upon the pattern of left ventricular depolarization.
6.
6. The hemodynamically more effective left ventricular pacemaker sites resulted in higher cardiac outputs than any of the right ventricular sites tested.
7.
7. The changes in cardiac performance when the heart is paced from various pacemaker sites is best explained by varying degrees of asynchrony during ventricular contraction and/or the position of the atrioventricular valves early in ventricular systole.
8.
8. The clinical implications of this study have been considered.

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Acute Haemodynamic and Echocardiographic Effects of Multiple Configurations of Left Ventricular Pacing Sites in Acute Myocardial Infarction: Experimental Study
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Citation Excerpt :
Previous studies have demonstrated that single site LV pacing is superior to RV pacing, so RV pacing as a standalone variant was not studied [20–22]. In addition, these studies have revealed that LV apex pacing has a favourable haemodynamic effect, probably because pacing from the apex creates a relatively physiological propagation of electrical conduction [15,23–25]. Prior studies have demonstrated that the earliest part that is activated is the middle inferior septum.
Left ventricular (LV) pacing is unsuccessful in a significant number of patients, mainly due to sub-optimal LV pacing location. Nevertheless, data about the impact of different pacing sites on LV function in ischaemic myocardium are scarce. The purpose of this study was to investigate the effect of combinations of alternative LV pacing sites on LV mechanics after experimental acute anterior myocardial infarction (AMI), in order to define the optimal configuration.
Atrioventricular epicardial pacing at alternative pacing sites was performed in 16 healthy pigs simultaneously, after experimental AMI. Standard right ventricular (RV) apical pacing was combined with: i) LV apex lateral wall; ii) LV basal posterior wall; iii) LV basal anterior wall, and; iv) LV basal anterior wall + LV basal posterior wall. Moreover the pacing configurations of, v) LV basal posterior wall + LV apex lateral wall; vi) LV basal posterior wall + LV basal anterior wall, and; vii) LV basal anterior wall + LV apex lateral wall were also investigated. Haemodynamic parameters, together with classic and novel echocardiographic indices were used, to evaluate the effect of each pacing combination. A speckle tracking technique using EchoPAC software was used.
After AMI, the pacing combination of LV apex lateral wall and LV basal posterior wall had the most favourable effect on LV function, leading to similar haemodynamic and torsional effects with sinus rhythm (all variables p>0.05).
In pig hearts after AMI, the combination of pacing LV apex lateral wall and LV basal posterior wall managed to maintain the LV function at a level comparable to the sinus rhythm.
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^☆: This study was supported in part by grants from the United States Public Health Service and the American Heart Association.

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Experimental studyEffect of pacemaker site on cardiac output and ventricular activation in dogs with complete heart block☆

Abstract

J. Thoracic and Cardiovas. Surg.

Am. J. Cardiol.

Am. Heart J.

The muscular reactions of the mamallian ventricles to artificial surface stimuli

Am. J. Physiol.

The effects of repetitive electric cardiac stimulation in dogs with complete heart block and experi-mental cardiac arrest

Circulation

Unequal right and left ventricular ejection with ectopic beats

Am. J. Physiol.

L'importance de la position des electrodes stimulatrices an cours du traitment d'un block auriculo-ventriculair post operatif total

Arch. mal. coeur

Synchronicity of ventricular contraction; observations comparing hemodynamic effects of atrial and ventricular pacing

Brit. Heart J.

The effects of right ventriculotomy upon activation of the epicardial surface of the canine right ventricle

Circulation

Experimental study
Effect of pacemaker site on cardiac output and ventricular activation in dogs with complete heart block☆