PO-02-206 A MECHANISM FOR PACING-INDUCED REGIONAL CONTRACTILE DYSFUNCTION MEDIATED BY RELEASED CATECHOLAMINES

Abstract

We have previously shown that non-excitatory epicardial stimulation (NES) increases measures of cardiac function mediated by local release of norepinephrine. In this further investigation we focused on the effects of NES on the local myocardial contractile pattern. Farm pigs were anesthetized and instrumented with a LV high-fidelity pressure/volume conductance transducer, thoracic aortic pressure transducer, left atrial (LA)/ LV epicardial electrodes, and sonomicrometer segment length (SL) gauges placed proximal (lateral base) and distal (posterior mid LV) to the LV stimulation site. During constant LA pacing, LV pulses (0.8ms, 2-3x threshold volts) were applied during the absolute refractory period before and after β-receptor blockade (BB, metoprolol). Regional contractile function was analyzed by constructing LVP vs. SL loops in a beat-by-beat fashion thus allowing characterization of local cardiac function in relation to LV pressure over the entire cardiac cycle. NES resulted in a local contractile dysfunction characterized by an early shortening, subsequent lengthening, and re-shortening pattern during the cardiac cycle in the SL gauge proximal (middle tracing), but not remote to the stimulation site (bottom tracing). The onset of early lengthening in the proximal SL coincided with peak pressure generation, followed by re-shortening as LV pressure fell. The LVP vs. SL loop was markedly altered. This contractile effect rapidly waned within 10-15 seconds after cessation of electrical stimulation and was abolished by BB. The NES induced dysfunction developed within an average of 5-10 seconds of stimulation onset and was accompanied by increases in several global indices of cardiac function (dP/dt, peak LVP, early aortic valve opening) which were also abrogated by B-blockade. These findings demonstrate that pacing elicits local catecholamine release that may cause dyssynergy and mimic the regional pacing-induced contractile dysfunction seen at pacing sites in man.