Effect of Pacing Site and Infarct Location on Regional Mechanics and Global Hemodynamics in a Model Based Study of Heart Failure

摘要

Clinical trials evaluating cardiac resynchronization therapy (CRT) have demonstrated that 30% of patients with heart failure and wide QRS do not respond to CRT (especially patients with myocardial infarcts). We have developed 3D numerical models of failing hearts, with and without chronic infarcts in different regions of the left ventricle. The hearts were coupled to a closed circulation, and the model included effects of the pericardium. The hearts were either paced at the right ventricular apex (RVA) or left ventricular free wall (LVFW). In normal and failing hearts, LV pump function was moderately better for LVFW pacing. In the normal heart model, heterogeneity of ejection strain was similar for RVA and LVFW pacing. However, in the failing heart model, LVFW pacing was associated with 44% less heterogeneity of ejection strain. This may be an important factor in the remodeling process associated with pacing.