Latissimus Dorsi Stimulation in Dynamic Cardiomyoplasty: How Should We Proceed?

Improved understanding of the mechanisms of action in dynamic cardiomyoplasty (DCMP) and continued research in the stimulation of the latissimus dorsi muscle (LDM) contribute to the development of new stimulation strategies aimed at improving DCMP outcomes. Cautious initiation of LDM stimulation sooner after surgery than currently practiced may provide the patient earlier hemodynamic assistance. During training and chronic stimulation, adjustment of stimulation amplitude, number of pulses in a burst, the interval between pulses, the synchronization ratio and the synchronization delay will all have important effects on the acute and chronic contractile properties of the LDM, thus impacting its capacity to improve cardiac function. Allowing the LDM periods of rest each day can be extremely beneficial to the muscle and may ultimately improve clinical outcome. Non-invasive monitoring of LDM contraction is essential to implementing and testing new stimulation regimes. Recent development of such monitoring techniques allows safe clinical evaluation of experimentally validated concepts. This review considers each LDM stimulation parameter in terms of improving LDM function and optimizing DCMP benefit during both training and chronic stimulation phases. Post-operative stimulation techniques currently possible with today's technology are discussed in light of recent research and clinical findings.