This Article Full Text Full Text (PDF) All Versions of this Article: 110/16/2395    most recent 01.CIR.0000145169.82004.CFv1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Bleasdale, R.A. Articles by Frenneaux, M.P. Search for Related Content PubMed PubMed Citation Articles by Bleasdale, R.A. Articles by Frenneaux, M.P. Related Collections Contractile function Congestive Pacemaker

(Circulation. 2004;110:2395-2400.)
© 2004 American Heart Association, Inc.

Heart Failure

Left Ventricular Pacing Minimizes Diastolic Ventricular Interaction, Allowing Improved Preload-Dependent Systolic Performance

R.A. Bleasdale, MD; M.S. Turner, MD; C.E. Mumford, MD; P. Steendijk, MD; V. Paul, MD; J.V. Tyberg, MD; J.A. Morris-Thurgood, MD; M.P. Frenneaux, MD

From the Department of Cardiology, Wales Heart Research Institute (R.A.B., M.S.T., C.E.M., J.A.M.-T., M.P.F.), Cardiff, United Kingdom; Cardiovascular Research Group, University of Calgary (J.V.T.), Alberta, Canada; Department of Cardiology, Ashford and St. Peters NHS Trust (V.P.), Surrey, United Kingdom; and Department of Cardiology, Leiden University Medical Center (P.S.), Leiden, the Netherlands.

Correspondence to Dr R.A. Bleasdale, Department of Cardiology, Wales Heart Research Institute, Heath Park, Cardiff CF14 4XN, United Kingdom. E-mail bleasdalera{at}aol.com

Received September 3, 2003; de novo received June 8, 2004; accepted July 7, 2004.

Background— Left ventricular (LV) pacing improves hemodynamics in patients with heart failure. We hypothesized that at least part of this benefit occurs by minimization of external constraint to LV filling from ventricular interaction.

Methods and Results— We present median values (interquartile ranges) for 13 heart failure patients with LV pacing systems implanted for New York Heart Association class III/IV limitation. We used the conductance catheter method to measure LV pressure and volume simultaneously. External constraint was measured from the end-diastolic pressure-volume relation recorded during inferior vena caval occlusion, during LV pacing, and while pacing was suspended. External constraint to LV filling was reduced by 3.0 (4.6 to 0.6) mm Hg from 4.8 (0.6 to 7.5) mm Hg (P<0.01) in response to LV pacing; effective filling pressure (LV end-diastolic pressure minus external constraint) increased by 4.0 (2.2 to 5.8) mm Hg from 17.7 (13.3 to 22.6; P<0.01). LV end-diastolic volume increased by 10 (3 to 11) mL from 238 (169 to 295) mL (P=0.01), whereas LV end-systolic volume did not change significantly (–1 [–2 to 3] mL from 180 [124 to 236] mL, P=0.97), which resulted in an increase in stroke volume of 11 (5 to 13) mL from 49 (38 to 59) mL (P<0.01). LV stroke work increased by 720 (550 to 1180) mL · mm Hg from 3400 (2110 to 4480) mL · mm Hg (P=0.01), and maximum dP/dt increased by 120 (2 to 161) mm Hg/s from 635 (521 to 767) mm Hg/s (P=0.03).

Conclusions— This study suggests a potentially important mechanism by which LV pacing may produce hemodynamic benefit. LV pacing minimizes external constraint to LV filling, resulting in an increase in effective filling pressure; the consequent increase in LV end-diastolic volume increases stroke volume via the Starling mechanism.

Key Words: heart failure • diastole • cardiac output • hemodynamics • pacing

This article has been cited by other articles:

				M. K. Friedberg, S. L. Roche, A. F. Mohammed, M. Balasingam, E. G. Atenafu, and P. F. Kantor Left Ventricular Diastolic Mechanical Dyssynchrony and Associated Clinical Outcomes in Children With Dilated Cardiomyopathy Circ Cardiovasc Imaging, July 1, 2008; 1(1): 50 - 57. [Abstract] [Full Text] [PDF]

				R. Lieberman, L. Padeletti, J. Schreuder, K. Jackson, A. Michelucci, A. Colella, W. Eastman, S. Valsecchi, and D. A. Hettrick Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction J. Am. Coll. Cardiol., October 17, 2006; 48(8): 1634 - 1641. [Abstract] [Full Text] [PDF]

				P. Steendijk, S. A. Tulner, J. J. Bax, P. V. Oemrawsingh, G. B. Bleeker, L. van Erven, H. F. Verwey, E. E. van der Wall, M. J. Schalij, and H. Putter Response to Letter Regarding Article, "Hemodynamic Effects of Long-Term Cardiac Resynchronization Therapy: Analysis by Pressure-Volume Loops" Circulation, August 29, 2006; 114(9): e372 - e372. [Full Text] [PDF]

				S Ellery, L Williams, and M Frenneaux Role of resynchronisation therapy and implantable cardioverter defibrillators in heart failure Postgrad. Med. J., January 1, 2006; 82(963): 16 - 23. [Abstract] [Full Text] [PDF]

				I. Schuster, G. Habib, C. Jego, F. Thuny, J.-F. Avierinos, G. Derumeaux, L. Beck, C. Medail, F. Franceschi, S. Renard, et al. Diastolic Asynchrony Is More Frequent Than Systolic Asynchrony in Dilated Cardiomyopathy and Is Less Improved by Cardiac Resynchronization Therapy J. Am. Coll. Cardiol., December 20, 2005; 46(12): 2250 - 2257. [Abstract] [Full Text] [PDF]

				R. C. P. Kerckhoffs, O. P. Faris, P. H. M. Bovendeerd, F. W. Prinzen, K. Smits, E. R. McVeigh, and T. Arts Electromechanics of paced left ventricle simulated by straightforward mathematical model: comparison with experiments Am J Physiol Heart Circ Physiol, November 1, 2005; 289(5): H1889 - H1897. [Abstract] [Full Text] [PDF]

				R A Bleasdale and M P Frenneaux Cardiac resynchronisation therapy: when the drugs don't work. Heart, December 1, 2004; 90(suppl_6): vi2 - vi4. [Full Text] [PDF]