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Am J Physiol Heart Circ Physiol 282: H2238-H2244, 2002. First published January 24, 2002; doi:10.1152/ajpheart.00684.2001
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Vol. 282, Issue 6, H2238-H2244, June 2002

Left ventricular resynchronization therapy in a canine model of left bundle branch block

Lili Liu1, Bruce Tockman1, Steven Girouard1, Joseph Pastore1, Greg Walcott2, Bruce KenKnight1, and Julio Spinelli1

1 Heart Failure Research Department, Guidant Corporation, St. Paul, Minnesota 55112; and 2 Cardiac Rhythm Management Laboratory, University of Alabama, Birmingham, Alabama 35186

Positive responses to left (LV) and biventricular (BV) stimulation observed in heart failure patients with left bundle branch block (LBBB) suggest a possible mechanism of LV resynchronization. An anesthetized canine LBBB model was developed using radio frequency ablation. Before and after ablation, LV pressure derivative over time (dP/dt) and aortic pulse pressure (PP) were assessed during normal sinus rhythm with right ventricle (RV), LV, or BV stimulation combined with four atrioventricular delays in six dogs. In three more dogs, M-mode echocardiograms of septal and LV posterior wall motion were obtained before and after LBBB and during LV stimulation. LBBB caused QRS widening and hemodynamics deterioration. Before ablation, stimulation alone worsened LV dP/dt and PP. After ablation, LV and BV stimulation maximally increased LV dP/dt by 16% and PP by 7% (P < 0.001), whereas little improvement was observed during RV stimulation. M-mode echocardiogram showed that LBBB resulted in a paradoxical septal wall motion that was corrected by LV stimulation. In conclusion, LV and BV stimulation improved cardiac function in a canine LBBB model via resynchronization of LV excitation and contraction.

paradoxical septal wall motion; electromechanical coordination


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