Electro-energetics of Biventricular, Septal and Conduction System Pacing

Frits W Prinzen; Joost Lumens; Jürgen Duchenn; Kevin Vernooy

doi:10.15420/aer.2021.30

Electro-energetics of Biventricular, Septal and Conduction System Pacing

Arrhythm Electrophysiol Rev. 2021 Dec;10(4):250-257. doi: 10.15420/aer.2021.30.

Authors

Frits W Prinzen¹, Joost Lumens², Jürgen Duchenn³, Kevin Vernooy^{4

5}

Affiliations

¹ Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.
² Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, the Netherlands.
³ Department of Cardiovascular Sciences, KU Leuven, Belgium.
⁴ Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+ (MUMC+), the Netherlands.
⁵ Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands.

Abstract

Abnormal electrical activation of the ventricles creates abnormalities in cardiac mechanics. Local contraction patterns, as reflected by strain, are not only out of phase, but also show opposing length changes in early and late activated regions. Consequently, the efficiency of cardiac pump function (the amount of stroke work generated by a unit of oxygen consumed), is approximately 30% lower in dyssynchronous than in synchronous hearts. Maintaining good cardiac efficiency appears important for long-term outcomes. Biventricular, left ventricular septal, His bundle and left bundle branch pacing may minimise the amount of pacing-induced dyssynchrony and efficiency loss when compared to conventional right ventricular pacing. An extensive animal study indicates maintenance of mechanical synchrony and efficiency during left ventricular septal pacing and data from a few clinical studies support the idea that this is also the case for left bundle branch pacing and His bundle pacing. This review discusses electro-mechanics and mechano-energetics under the various paced conditions and provides suggestions for future research.

Keywords: Myocardial work; biventricular pacing; conduction system pacing; efficiency; septal pacing.

Publication types

Review