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Articles in PresS, published online ahead of print January 24, 2002
Am J Physiol Heart Circ Physiol, 10.1152/ajpheart.00684.2001
Submitted on August 2, 2001
Accepted on January 21, 2002
1 Heart Failure Research, Guidant Corporation, St. Paul, MN, USA
2 Cardiac Rhythm Management Laboratory, University of Alabama, Birmingham, AL, USA
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. Methods: An anesthetized canine LBBB model was developed using radio-frequency ablation. Before and after ablation, LVdP/dt and aortic pulse pressure(PP) were assessed during normal sinus rhythm with right ventricle(RV), LV, or BV stimulation combined with four atrio-ventricular delays in 6 dogs. In an additional 3 dogs, M-mode echocardiograms of septal and LV posterior wall motion were obtained before and after LBBB and during LV stimulation. Results: LBBB caused QRS widening and hemodynamics deterioration. Before ablation, stimulation alone worsened LVdP/dt and PP. After ablation, LV and BV stimulation maximally increased LVdP/dt by 16% and PP by 7%(p<0.001), while little improvement was observed during RV stimulation. M-mode Echo showed that LBBB resulted in a paradoxical septal wall motion that was corrected by LV stimulation. Conclusions: LV and BV stimulation improved cardiac function in a canine LBBB model via resynchronization of LV excitation and contraction.
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