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Circulation. 2002;106:1760-1763
Published online before print September 23, 2002, doi: 10.1161/01.CIR.0000035037.11968.5C
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(Circulation. 2002;106:1760.)
© 2002 American Heart Association, Inc.


Brief Rapid Communications

Systolic Improvement and Mechanical Resynchronization Does Not Require Electrical Synchrony in the Dilated Failing Heart With Left Bundle-Branch Block

Christophe Leclercq, MD*; Owen Faris, BA*; Richard Tunin, MS; Jennifer Johnson, RN; Ritsuchi Kato, MD, PhD; Frank Evans, PhD; Julio Spinelli, PhD; Henry Halperin, MD; Elliot McVeigh, PhD; David A. Kass, MD

From the Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Md (C.L., R.T., J.J., R.K., H.H., D.A.K.); National Heart, Lung and Blood Institute/Laboratory of Cardiac Energetics, National Institutes of Health, Bethesda, Md (O.F., F.E., E.M.); and Cardiac Pacemakers/Guidant, St Paul, Minneapolis, Minn (J.S.).

Correspondence to David A. Kass, Halsted 500, Johns Hopkins Hospital, 600 N. Wolfe St, Baltimore, MD 21287. E-mail dkass{at}jhmi.edu

Background— Biventricular (BiV) and left ventricular (LV) pacing similarly augment systolic function in left bundle-branch block (LBBB)-failing hearts despite different electrical activation. We tested whether electrical synchrony is required to achieve mechanical synchronization and functional benefit from pacing.

Methods and Results— Epicardial mapping, tagged MRI, and hemodynamics were obtained in dogs with LBBB-failing hearts during right atrial, LV, and BiV stimulation. BiV and LV both significantly improved chamber hemodynamics (eg, 25% increase in dP/dtmax and aortic pulse pressure) compared with atrial pacing-LBBB, and this improvement correlated with mechanical resynchronization. Electrical dispersion, however, decreased 13% with BiV but increased 23% with LV pacing (P<0.01).

Conclusion— Improved mechanical synchrony and function do not require electrical synchrony. Mechanical coordination plays the dominant role in global systolic improvement with either pacing approach.


Key Words: heart failure • pacing • electrical stimulation • bundle-branch block • ventricles




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J Am Coll CardiolHome page
J. J. Bax, G. Ansalone, O. A. Breithardt, G. Derumeaux, C. Leclercq, M. J. Schalij, P. Sogaard, M. St. John Sutton, and P. Nihoyannopoulos
Echocardiographic evaluation of cardiac resynchronization therapy: ready for routine clinical use?: A critical appraisal
J. Am. Coll. Cardiol., July 7, 2004; 44(1): 1 - 9.
[Abstract] [Full Text] [PDF]


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CirculationHome page
M. S. Turner, R. A. Bleasdale, D. Vinereanu, C. E. Mumford, V. Paul, A. G. Fraser, and M. P. Frenneaux
Electrical and Mechanical Components of Dyssynchrony in Heart Failure Patients With Normal QRS Duration and Left Bundle-Branch Block: Impact of Left and Biventricular Pacing
Circulation, June 1, 2004; 109(21): 2544 - 2549.
[Abstract] [Full Text] [PDF]


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HeartHome page
A Auricchio and C M Yu
Beyond the measurement of QRS complex toward mechanical dyssynchrony: cardiac resynchronisation therapy in heart failure patients with a normal QRS duration
Heart, May 1, 2004; 90(5): 479 - 481.
[Abstract] [Full Text] [PDF]


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HeartHome page
P D. Bella and C Carbucicchio
Non-contact left ventricular endocardial mapping for cardiac resynchronisation therapy: a "slow conduction" towards the fast solution
Heart, May 1, 2004; 90(5): 483 - 484.
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HeartHome page
M S Turner, R A Bleasdale, C E Mumford, M P Frenneaux, and J A Morris-Thurgood
Left ventricular pacing improves haemodynamic variables in patients with heart failure with a normal QRS duration
Heart, May 1, 2004; 90(5): 502 - 505.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
J. J. M. Zwanenburg, M. J. W. Gotte, J. P. A. Kuijer, R. M. Heethaar, A. C. van Rossum, and J. T. Marcus
Timing of cardiac contraction in humans mapped by high-temporal-resolution MRI tagging: early onset and late peak of shortening in lateral wall
Am J Physiol Heart Circ Physiol, May 1, 2004; 286(5): H1872 - H1880.
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W. G. Stevenson and M. O. Sweeney
Single Site Left Ventricular Pacing for Cardiac Resynchronization
Circulation, April 13, 2004; 109(14): 1694 - 1696.
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CirculationHome page
J.-J. Blanc, V. Bertault-Valls, M. Fatemi, M. Gilard, P.-Y. Pennec, and Y. Etienne
Midterm Benefits of Left Univentricular Pacing in Patients With Congestive Heart Failure
Circulation, April 13, 2004; 109(14): 1741 - 1744.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
M. R. Mehra and B. H. Greenberg
Cardiac resynchronization therapy: caveat medicus!
J. Am. Coll. Cardiol., April 7, 2004; 43(7): 1145 - 1148.
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M. Penicka, J. Bartunek, B. De Bruyne, M. Vanderheyden, M. Goethals, M. De Zutter, P. Brugada, and P. Geelen
Improvement of Left Ventricular Function After Cardiac Resynchronization Therapy Is Predicted by Tissue Doppler Imaging Echocardiography
Circulation, March 2, 2004; 109(8): 978 - 983.
[Abstract] [Full Text] [PDF]


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Am. J. Physiol. Heart Circ. Physiol.Home page
P. Steendijk, S. A. F. Tulner, J. J. Schreuder, J. J. Bax, L. van Erven, E. E. van der Wall, R. A. E. Dion, M. J. Schalij, and J. Baan
Quantification of left ventricular mechanical dyssynchrony by conductance catheter in heart failure patients
Am J Physiol Heart Circ Physiol, February 1, 2004; 286(2): H723 - H730.
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C. Leclercq and J. M. Hare
Ventricular Resynchronization: Current State of the Art
Circulation, January 27, 2004; 109(3): 296 - 299.
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J Am Coll CardiolHome page
H. Bader, S. Garrigue, S. Lafitte, S. Reuter, P. Jais, M. Haissaguerre, J. Bonnet, J. Clementy, and R. Roudaut
Intra-left ventricular electromechanical asynchrony: A new independent predictor of severe cardiac events in heart failure patients
J. Am. Coll. Cardiol., January 21, 2004; 43(2): 248 - 256.
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J Am Coll CardiolHome page
A. Auricchio, C. Stellbrink, C. Butter, S. Sack, J. Vogt, A. R. Misier, D. Bocker, M. Block, J. H. Kirkels, Pacing Therapies in Congestive Heart Failure (PATH, et al.
Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2109 - 2116.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
D. A. Kass
Predicting cardiac resynchronization response by qrs duration: The long and short of it
J. Am. Coll. Cardiol., December 17, 2003; 42(12): 2125 - 2127.
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Am. J. Physiol. Heart Circ. Physiol.Home page
O. P. Faris, F. J. Evans, A. J. Dick, V. K. Raman, D. B. Ennis, D. A. Kass, and E. R. McVeigh
Endocardial versus epicardial electrical synchrony during LV free-wall pacing
Am J Physiol Heart Circ Physiol, November 1, 2003; 285(5): H1864 - H1870.
[Abstract] [Full Text] [PDF]


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J Am Coll CardiolHome page
L. Warner Stevenson
The points for pacing
J. Am. Coll. Cardiol., October 15, 2003; 42(8): 1460 - 1462.
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D. D. Spragg, C. Leclercq, M. Loghmani, O. P. Faris, R. S. Tunin, D. DiSilvestre, E. R. McVeigh, G. F. Tomaselli, and D. A. Kass
Regional Alterations in Protein Expression in the Dyssynchronous Failing Heart
Circulation, August 26, 2003; 108(8): 929 - 932.
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J Am Coll CardiolHome page
X. A. A. M. Verbeek, K. Vernooy, M. Peschar, R. N. M. Cornelussen, and F. W. Prinzen
Intra-ventricular resynchronization for optimal left ventricular function during pacing in experimental left bundle branch block
J. Am. Coll. Cardiol., August 6, 2003; 42(3): 558 - 567.
[Abstract] [Full Text] [PDF]