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Physiology of biventricular pacing

  • Invasive Electrophysiology and Pacing
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Abstract

Biventricular pacing (cardiac resynchronization therapy [CRT]) has been shown to be a very effective therapy for patients with heart failure and dyssynchrony, with improved survival now shown in a recent trial. Electrical dyssynchrony, usually quantified by the duration of the QRS complex, is distinct from mechanical dyssynchrony. Intraventricular mechanical dyssynchrony is most commonly manifest by decreased septal work with concomitant early lateral wall prestretch and subsequent inefficient late contraction. Intraventricular dyssynchrony appears to be more predictive of response to CRT than interventricular dyssynchrony. Mechanical left ventricular dyssynchrony also is associated with regional molecular derangements in connexin-43, stress response kinases, and tumor necrosis factor-α. These molecular derangements may lead to abnormalities in conduction velocity and action potential duration, which may predispose to ventricular arrhythmia. Biventricular pacing corrects abnormal regional wall stresses and results in electrical, mechanical, and molecular left ventricular remodeling.

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Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins School of Medicine, 720 Rutland Avenue, 835 Ross Building, 21205, Baltimore, MD, USA

    David A. Kass MD

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  1. Kenneth C. Bilchick MD
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  2. Robert H. Helm MD
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  3. David A. Kass MD
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Correspondence to David A. Kass MD.

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Bilchick, K.C., Helm, R.H. & Kass, D.A. Physiology of biventricular pacing. Curr Cardiol Rep 9, 358–365 (2007). https://doi.org/10.1007/BF02938362

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