Pacing polarity and left ventricular mechanical activation sequence in cardiac resynchronization therapy

  • Hyan Suk Yang
  • Giuseppe Caracciolo
  • Partho P. Sengupta
  • Ramil Goel
  • Krishnaswamy Chandrasekaran
  • Komandoor Srivathsan
Article
First Online:
Received:
Accepted:

Abstract

Objective

The aim of this study is to evaluate the relationship between polarity of left ventricular (LV) pacing and the resultant regional, global, and transmural mechanical sequence of contraction.

Background

Cardiac resynchronization therapy (CRT) is widely utilized in patients with drug refractory congestive heart failure with systolic dysfunction (EF <35 %) and intraventricular conduction delay (QRS duration >120 ms). However, little is known about polarity of pacing stimulation and the resultant differences in LV mechanics.

Methods

The polarity of pacing was altered sequentially in 20 patients (73 ± 13, 16 males) with preexisting biventricular devices with potential choice of multiple vectors for pacing stimulation. Initial unipolar or extended bipolar configurations were switched to bipolar configuration or vice versa, and echocardiographic images were acquired for off-line analysis. Regional and global LV longitudinal and radial mechanics were assessed selectively from the subendocardial and subepicardial regions with 2D speckle-tracking echocardiography. Left ventricular capture by each vector configuration was confirmed by local lead capture and appropriate QRS alteration.

Results

Unipolar pacing resulted in increased dispersion of LV regional endocardial strains with a higher base-to-apex gradients of longitudinal shortening strains (P < 0.05). LV longitudinal shortening strain magnitude was higher at LV base with bipolar stimulation in comparison with unipolar stimulation (−10.5 ± 10.5 vs. −4.2 ± 6.3, P = 0.02).

Conclusion

There is a difference in the mechanical activation sequence of the LV between unipolar vs. bipolar pacing stimulation. This may have important implications for CRT.

Keywords

Resynchronization Heart failure Pacemaker 

Abbreviations

2D CPA

2D cardiac performance analysis

CRT

Cardiac resynchronization therapy

CRT-D

Cardiac resynchronization therapy defibrillator

CS

Circumferential strain

DMI

Doppler myocardial imaging

ECG

Electrocardiogram

EF

Ejection fraction

LS

Longitudinal strain

LV

Left ventricular/left ventricle

RS

Radial strain

RV

Right ventricular

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Hyan Suk Yang
    • 1
  • Giuseppe Caracciolo
    • 1
  • Partho P. Sengupta
    • 1
  • Ramil Goel
    • 1
  • Krishnaswamy Chandrasekaran
    • 1
  • Komandoor Srivathsan
    • 1
  1. 1.Division of Cardiovascular DiseasesMayo ClinicPhoenixUSA

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