Effects of single- and biventricular pacing on temporal and spatial dynamics of ventricular contraction

Resynchronization is frequently used for the treatment of heart failure, but the mechanism for improvement is not entirely clear. In the present study, the temporal synchrony and spatiotemporal distribution of left ventricular (LV) contraction was investigated in eight dogs during right atrial (RA), right ventricular apex (RVa), and biventricular (BiV) pacing using tagged magnetic resonance imaging. Mechanical activation (MA; the onset of circumferential shortening) was calculated from the images throughout the left ventricle for each pacing protocol. MA width (time for 20-90% of the left ventricle to contract) was significantly shorter during RA (43.6 ± 17.1 ms) than BiV and RVa pacing (67.4 ± 15.2 and 77.6 ± 16.4 ms, respectively). The activation delay vector (net delay in MA from one side of the left ventricle to the other) was significantly shorter during RA (18.9 ± 8.1 ms) and BiV (34.2 ± 18.3 ms) than during RVa (73.8 ± 16.3 ms) pacing. Rate of LV pressure increase was significantly lower during RVa than RA pacing (1,070 ± 370 vs. 1,560 ± 300 mmHg/s) with intermediate values for BiV pacing (1,310 ± 220 mmHg/s). BiV pacing has a greater impact on correcting the spatial distribution of LV contraction than on improving the temporal synchronization of contraction. Spatiotemporal distribution of contraction may be an important determinant of ventricular function.