Why Ischemic Hearts Respond Less to Cardiac Resynchronisation Therapy. A Modeling Study

  • Piet Claus
  • Bart Bijnens
  • Ole-Alexander Breithardt
  • George R. Sutherland
Conference paper
Part of the Lecture Notes in Computer Science book series (LNCS, volume 2674)


Cardiac Resynchronisation Therapy (CRT) by means of simultaneous biventricular or multisite leftventricular pacing is a new technique for improving left ventricular systolic performance in patients with heart failure and conduction abnormalities (e.g. left bundle branch block). However, different pathological cases do react differently to CRT and the underlying mechanisms are poorly understood. This paper presents a study of the mechanical effects of delayed activation on ejection and regional deformation using a simplified mathematical model. These effects are studied in normal and dilated hearts, and ischemic non-dilated and dilated hearts. From these simulations we derive dependencies of regional performance parameters on delayed activation and discuss why ischemic hearts do respond less to CRT.


Cardiac Resynchronisation Therapy Biventricular Pace Delayed Activation Ischemic Simulation Ischemic Segment 
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  1. 1.
    S. Cazeau, D. Graz, A. Lazarus, P. Ritter and J. Mugica. Multisite stimulation for correction of cardiac asynchrony. Heart 84(6) 2000 579–581.CrossRefGoogle Scholar
  2. 2.
    S. Cazeau, C. Leclerq, T. Lavergne, S. Walker, C. Varma, C. Linde, S. Garrigue, L. Kappenberger, G.A. Haywood M. Santini and C. Bailleul. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N. Engl. J. Med. 344(12) 2001 873–80.CrossRefGoogle Scholar
  3. 3.
    A. Auricchio, C. Stellbrink, S. Sack, M. Block, J. Vogt, P. Bakker, C. Huth, F. Schondube, U. Wolfhard, D. Bocker, O. Krahnefeld and H. Kirkels. Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay. J. Am. Coll. Cardiol. 39(12) 2002 2026–2033.CrossRefGoogle Scholar
  4. 4.
    C. Linde, C. Leqlercq, S. Rex, S. Garrigue, T. Lavergne, S. Cazeau, W. McKenna, M. Fitzgerald, J.C. Deharo, C. Alonso, S. Walker, F. Braunschweig, C. Bailleul and J.C. Daubert. Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STImulation in Cardiomyopathy (MUSTIC) study. J. Am. Coll. Cardiol. 40(1) 2002 111–118.CrossRefGoogle Scholar
  5. 5.
    W.T. Abraham, W.G. Fisher, A.L. Smith, D.B. Delurgio, A.R. Leon, E. Loh, D.Z. Kocovic, M. Packer, A.L. Clavell, D.L. Hayes, M. Ellestad, R.J. Trupp, J. Underwood, F. Pickering, C. Truex, P. McAtee and J. Messenger. Cardiac resynchronization in chronic heart failure. N. Engl. J. Med. 346(24) 2002 1845–1853.CrossRefGoogle Scholar
  6. 6.
    P. Claus, B. Bijnens, F. Weidemann, C. Dommke, V. Bito, F. Heinzel, K. Sipido, I. De Scheerder, F.E. Rademakers and G.R. Sutherland. Post-systolic thickening in ischemic myocardium: A simple mathematical model for simulating regional deformation. In T. Katila, J. Nennonen, I.E. Magnin et al., eds, Functional Imaging and Modeling of the Heart: fisrt international workshop, volume 2230 of Lecture Notes in Computer Science 2001 135–139.CrossRefGoogle Scholar
  7. 7.
    J.M. Guccione, G.S. Le Prell, P.P. de Tombe and W.C. Hunter. Measurements of active myocardial tension under a wide range of physiological loading conditions. J. Biomechanics 30(2) 1997 189–192.cCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • Piet Claus
    • 1
  • Bart Bijnens
    • 1
  • Ole-Alexander Breithardt
    • 2
  • George R. Sutherland
    • 1
  1. 1.Department of CardiologyK.U.Leuven, University Hospitals GasthuisbergLeuvenBelgium
  2. 2.Department of CardiologyUniversity Hospital AachenAachenGermany

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