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The European Society of Cardiology

Structural, electrical and mechanical remodeling of the canine heart in AV-block and LBBB

Maaike Peschara, Kevin Vernooya, Richard N Cornelussena, Xander A.A.M Verbeeka, Robert S Renemana, Marc A Vosb and Frits W Prinzena,*

a Department of Physiology, Maastricht University, Maastricht, The Netherlands
b Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands

Received 3 May 2004; accepted 24 May 2004.

* Frits W. Prinzen, PhD, Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands. Tel.: +31-43-3881080; fax: +31-43-3884166
frits.prinzen{at}fys.unimaas.nl

Abstract

Long lasting alterations in loading conditions lead to adaptations in structural remodeling (hypertrophy, changes in the size of the cardiac muscle and the cavity and its connective tissue content), mechanical remodeling (abnormal contraction and relaxation of the heart) and electrical remodeling (increased sensitivity to arrhythmias). In canine hearts with atrioventricular (AV)-block (bradycardia-induced volume overload) the three kinds of remodeling follow different time courses, emphasizing the complexity of myocardial adaptation processes. This is further emphasized by the lack of reversibility of electrical remodeling when normalizing volume load by pacing at physiological heart rate. Evidence is increasing that long lasting asynchronous activation (ventricular pacing, left bundle branch block) leads to eccentric hypertrophy with regional differences in structural, electrical and mechanical remodeling.

Key Words: Hypertrophy • Action potential duration • Force frequency relation • Reverse remodeling • Left bundle branch block


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