Left ventricular pacing site and timing optimization during biventricular pacing using a multielectrode patch in pigs George Berberian, MD, T. Alexander.

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Presentation transcript:

Left ventricular pacing site and timing optimization during biventricular pacing using a multielectrode patch in pigs George Berberian, MD, T. Alexander Quinn, MS, Santos E. Cabreriza, MBA, Jon-Emile S. Kenny, BS, Cara A. Garofalo, MD, Alan D. Weinberg, MS, Henry M. Spotnitz, MD The Journal of Thoracic and Cardiovascular Surgery Volume 134, Issue 3, Pages 574-578 (September 2007) DOI: 10.1016/j.jtcvs.2007.04.050 Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Diagram of the multielectrode patch with 5 bipolar electrodes and corresponding left ventricular sites. Dimensions are indicated in centimeters. Apical leads were sewn in. APEX, Apical; CIRC, circumflex; IL, inferolateral; IM, inferomedial; OM, obtuse margin; PDA, posterior descending. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 574-578DOI: (10.1016/j.jtcvs.2007.04.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Diagram of the anatomic location of the multielectrode patch and contained electrodes on the left ventricle (dark circles). Pacing leads were also placed on the apex (open circle), anterior surface of the right ventricle (square), and right atrium (triangle). The Journal of Thoracic and Cardiovascular Surgery 2007 134, 574-578DOI: (10.1016/j.jtcvs.2007.04.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 A representative plot of beat-to-beat cardiac output measurements over 27 minutes of continuous data collection during 1 experiment. CO, Cardiac output. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 574-578DOI: (10.1016/j.jtcvs.2007.04.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Surface plot demonstrating percentage change from mean cardiac output for all possible left ventricular pacing site/right–left ventricular delay combinations averaged over 8 experiments. Contour lines indicate a 1% change in cardiac output. The highest values are represented by red. APEX, Apical; CIRC, circumflex; CO, cardiac output; IL, inferolateral; IM, inferomedial; LVPS, left ventricular pacing site; OM, obtuse margin; PDA, posterior descending artery; RLD, right ventricular–left ventricular delay. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 574-578DOI: (10.1016/j.jtcvs.2007.04.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Response surfaces relating left and right ventricular dP/dtmax and the area of the normalized right ventricular–left ventricular pressure diagram, APP, to all possible left ventricular pacing site/right ventricular–left ventricular delay combinations averaged over 7 experiments. Contour lines represent 1% changes in measured values. For surfaces of dP/dtmax, the highest values are represented by red, and for surfaces of APP, complete synchrony (APP = 0) is represented by white.APEX, Apical; APP, area of the normalized right ventricular–left ventricular pressure diagram; CIRC, circumflex; dP/dtmax, maximum rate of pressure rise; IL, inferolateral; IM, inferomedial; LV, left ventricle; OM, obtuse margin; PDA, posterior descending artery; RV, right ventricle. The Journal of Thoracic and Cardiovascular Surgery 2007 134, 574-578DOI: (10.1016/j.jtcvs.2007.04.050) Copyright © 2007 The American Association for Thoracic Surgery Terms and Conditions