The Left Ventricular Apex is the Optimal Site for Pediatric Pacing:
- 25 May 2004
- journal article
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 27 (6p2), 837-843
- https://doi.org/10.1111/j.1540-8159.2004.00544.x
Abstract
Pacing at the commonly used right ventricular (RV) apex results in impaired ventricular performance. Previous animal studies indicated that the left ventricular (LV) apex is a superior pacing site. The purpose of this study was to investigate in dogs whether this good performance is associated with a more synchronous electrical activation pattern of the LV and whether the LV apex is also a good pacing site in children. In 11 healthy dogs and 8 children undergoing cardiac surgery, dual chamber pacing was performed at the RV apex, LV apex and LV lateral free wall (LVFW). In dogs, a basket electrode was inserted into the LV to assess pattern and timing of LV endocardial activation. In the children, hemodynamic measurements were performed immediately after recovery from cardiopulmonary bypass. In dogs, LV apex pacing resulted in synchronous activation around the LV circumference whereas RV apex and LVFW pacing resulted in asynchrony of activation between the septum and LVFW. In both canine and children's hearts most hemodynamic variables remained at sinus rhythm level during LV apex pacing, but LVdPdtmax, stroke work (dogs), and pulse pressure (children) were reduced as compared with sinus rhythm during RV apex and LVFW pacing. LV apex pacing results in synchronous activation of the LV and is, in adult dogs and in children, associated with superior hemodynamic performance. (PACE 2004; 27 [Pt. II]:837–843)Keywords
This publication has 29 references indexed in Scilit:
- Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node DysfunctionCirculation, 2003
- Single Versus Dual Chamber Pacing in the Young:Pacing and Clinical Electrophysiology, 2003
- Resynchronization pacing is a useful adjunct to the management of acute heart failure after surgery for congenital heart defectsThe American Journal of Cardiology, 2001
- Optimization of Ventricular Function by Improving the Activation Sequence During Ventricular PacingPacing and Clinical Electrophysiology, 1998
- The Effect of Ventricular Activation Sequence on Cardiac Performance During PacingPacing and Clinical Electrophysiology, 1996
- Septal ventricular pacing in the immature canine heart: A new perspectiveAmerican Heart Journal, 1991
- Transmural activations and stimulus potentials in three-dimensional anisotropic canine myocardium.Circulation Research, 1988
- Total Excitation of the Isolated Human HeartCirculation, 1970
- Optimal Electrode Implantation Site for Asynchronous Dipolar Cardiac PacingAnnals of Surgery, 1968
- Effect of pacemaker site on cardiac output and ventricular activation in dogs with complete heart blockThe American Journal of Cardiology, 1964