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Am J Physiol Heart Circ Physiol 283: H1370-H1378, 2002. First published May 23, 2002; doi:10.1152/ajpheart.00051.2002
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Vol. 283, Issue 4, H1370-H1378, October 2002

Quantification of interventricular asynchrony during LBBB and ventricular pacing

Xander A. A. M. Verbeek, Kevin Vernooy, Maaike Peschar, Theo Van der Nagel, Arne Van Hunnik, and Frits W. Prinzen

Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, 6200 MD Maastricht, The Netherlands

The quantification of mechanical interventricular asynchrony (IVA) was investigated. In 12 dogs left bundle branch block (LBBB) was induced by radio frequency ablation. Left ventricular (LV) and right ventricular (RV) pressures were recorded before and after induction of LBBB and during LBBB + LV apex pacing at different atrioventricular (AV) delays. Four IVA measures were validated using computer simulations on experimentally obtained pressure signals. The most robust measure for IVA was the time delay between the upslope of the LV and RV pressure signals (Delta Tup), estimated by cross correlation. The induction of experimental LBBB decreased Delta Tup from -6.9 ± 7.0 ms (RV before LV) to -33.9 ± 7.6 ms (P < 0.05) in combination with a significant decrease of LV maximal first derivative of pressure development over time (dP/dtmax). During LV apex pacing, Delta Tup increased with decreasing AV delay up to +20.9 ± 14.6 ms (P < 0.05). Interventricular resynchronization (Delta Tup = 0 ms) significantly improved LV dP/dtmax by 15.1 ± 5.9%. QRS duration increased significantly after induction of LBBB but did not change during LV apex pacing. In conclusion, Delta Tup is a reliable measure of mechanical IVA, which adds valuable information concerning the nature of asynchronous activation of the ventricles.

left bundle branch block; resynchronization


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