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Fruelund PZ, Sommer A, Lundbye-Christensen S, Graff C, Søgaard P, Riahi S, Zaremba T. The role of contractile dyssynchrony in pacing-induced cardiomyopathy: detailed assessment using index of contractile asymmetry. Cardiovasc Ultrasound 2023; 21:8. [PMID: 37127676 PMCID: PMC10150541 DOI: 10.1186/s12947-023-00308-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/28/2023] [Indexed: 05/03/2023] Open
Abstract
AIMS The pathophysiological effects of chronic right ventricular pacing and the role of right ventricular lead position are not well understood. Therefore, we investigated the association between left ventricular contractile dyssynchrony and pacing-induced cardiomyopathy (PICM) in patients with chronic right ventricular pacing. Furthermore, we assessed the association between right ventricular lead location and left ventricular contractile dyssynchrony. METHODS This was a retrospective study using data from 153 pacemaker patients with normal (≥ 50%) pre-implant left ventricular ejection fraction (LVEF). Baseline and follow-up echocardiograms were analyzed, and PICM was defined as LVEF < 50% with ≥ 10% decrease in LVEF after pacemaker implantation. Relative index of contractile asymmetry (rICA), a novel strain rate-based method, was calculated to quantify left ventricular contractile dyssynchrony between opposing walls in the three apical views. Right ventricular lead position was categorized into anterior septum, posterior septum, free wall, and apex based on contrast-enhanced cardiac computed tomography. RESULTS Forty-seven (31%) developed PICM. Overall contractile dyssynchrony, measured by mean rICA, was higher in the PICM group compared with the non-PICM group (1.19 ± 0.21 vs. 1.03 ± 0.19, p < 0.001). Left ventricular anterior-inferior dyssynchrony, assessed in the apical two-chamber view, was independently associated with PICM (p < 0.001). Thirty-seven (24%) leads were implanted anterior septal, 11 (7.2%) posterior septal, 74 (48.4%) apical, and 31 (20.3%) free wall. Left ventricular anterior-inferior dyssynchrony was significantly different between the four pacing lead locations (p < 0.01) with the highest rICA observed in the posterior septal group (1.30 ± 0.37). CONCLUSIONS PICM is significantly associated increased contractile dyssynchrony assessed by rICA. This study suggests that especially left ventricular dyssynchrony in the anterior-inferior direction is associated with PICM, and pacing the right ventricular posterior septum resulted in the highest degree of anterior-inferior dyssynchrony. Quantification of left ventricular dyssynchrony by rICA provides important insights to the potential pathophysiology of PICM and the impact of right ventricular lead position.
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Affiliation(s)
- Patricia Zerlang Fruelund
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark.
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark.
- Department of Internal Medicine, Regional Hospital of Randers, Randers, Denmark.
| | - Anders Sommer
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
| | - Søren Lundbye-Christensen
- Unit of Clinical Biostatistics, Aalborg University Hospital, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Claus Graff
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 7, Aalborg Øst, 9220, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Clinical Medicine, Aalborg University, Forskningens Hus, Sdr. Skovvej 15, Aalborg, 9000, Denmark
| | - Tomas Zaremba
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
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Xin MK, Gao P, Zhang SY. Effects of long-term right ventricular apex pacing on left ventricular dyssynchrony, morphology and systolic function. Int J Cardiol 2021; 331:91-99. [PMID: 33529668 DOI: 10.1016/j.ijcard.2021.01.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Right ventricular apex (RVA) is still the most common implanted site in the world. There are a large number of RVA pacing population who have been carrying dual-chamber permanent pacemaker (PPM) over decades. Comparison of left ventricular dyssynchrony, morphology and systolic function between RVA pacing population and healthy population is unknown. METHOD This case-control study enrolled 61 patients suffered from complete atrioventricular block (III°AVB) for replacement of dual-chamber PPM. Then, 61 healthy controls matched with PPM patients in gender, age, follow-up duration and complications were included. The lead impedance, pacing threshold and sensing were compared between at implantation and long-term follow-up. Left ventricular (LV) dyssynchrony, morphology and systolic function were compared between RVA pacing population (RVA group) and healthy population (healthy group) at implantation (baseline) and follow-up. And clarify the predictors of LV systolic function in RVA group at follow-up. RESULTS After 112.44 ± 34.94 months of follow-up, comparing with parameters at implantation, atrial lead impedance decreased significantly (690 ± 2397 Ω vs 613 ± 2257 Ω, p = 0.048); atrial pacing threshold has a increased trend and P-wave amplitude has a decreased trend, but there was no statistical differences; while, RVA ventricular lead threshold increased significantly (0.50 ± 0.23 V vs 0.91 ± 0.47 V, p < 0.001), impedance (902 ± 397 Ω vs 680 ± 257 Ω,p < 0.001) and R-wave amplitude (11.71 ± 9.40mv vs 7.00 ± 6.91 mv, p < 0.001) decreased significantly. Compared with healthy group, long-term RVA pacing significantly increased ventricular dyssynchrony (mean QRS duration, 156.21 ± 29.80 ms vs 97.08 ± 15.70 ms, p < 0.001), left atrium diameter (LAD, 40.61 ± 6.15 mm vs 37.49 ± 4.80 mm,p = 0.002), left ventricular end-diastolic diameter (LVEDD, 49.15 ± 5.93 mm vs 46.41 ± 3.80 mm,p = 0.003), left ventricular hypertrophy (LVMI, 121.86 ± 41.52 g/m2 vs 98.41 ± 25.29 g/m2,p < 0.001), significantly deteriorated degree of tricuspid regurgitation (p < 0.001), and significantly decreased left ventricular ejection fraction (LVEF, 61.38 ± 8.10% vs 64.64 ± 5.85%, p = 0.012), but after long-term RVA pacing, the mean LVEF was still more than 50%. Long-term RVA group LVEF was negatively correlated with preimplantation LVMI (B = -0.055,t = -2.244,p = 0.029), LVMI at follow-up (B = -0.081,t = -3.864,p = 0.000) and tricuspid regurgitation at follow-up (B = -3.797,t = -3.599,p = 0.001). CONCLUSION In conclusion, although long-term RVA pacing has significantly effects on left ventricular dyssynchrony, morphology and systolic function in III°AVB patients, the mean LVEF is still >50%. High preimplantation LVMI can predict the decline of LVEF.
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Affiliation(s)
- Man-Kun Xin
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Peng Gao
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - Shu-Yang Zhang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China.
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Wang J, Liang Y, Wang W, Chen X, Bai J, Chen H, Su Y, Chen R, Ge J. Left bundle branch area pacing is superior to right ventricular septum pacing concerning depolarization-repolarization reserve. J Cardiovasc Electrophysiol 2019; 31:313-322. [PMID: 31778249 DOI: 10.1111/jce.14295] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 11/03/2019] [Accepted: 11/19/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Left bundle branch area pacing (LBBAP) has recently been reported to be a new physiological pacing strategy with clinical feasibility and safety. The present study aims to investigate depolarization-repolarization measures including QT interval, QT dispersion (QTD), and Tpeak-end interval (Tp Te ) in this novel LBBAP strategy. METHODS AND RESULTS A total of 131 pacing-indicated patients were prospectively enrolled and randomized to the LBBAP group (n = 66) and right ventricular septum pacing (RVSP) group (n = 65). LBBAP was successfully achieved in 61 subjects with stable lead performance and comparable complications (ie, pocket hematoma, lead perforation, and dislodgement) compared with RVSP. Of the 61 patients with successful LBBAP, the mean LV peak activation time was 67.89 ± 6.80 ms, with the LBB potential mapped in 46 cases (75.4%). Electrocardiogram (ECG) indices were compared between these two groups before and after implantation. As a result, LBBAP yielded a narrower paced QRS duration (121.49 ± 9.87 ms vs 145.62 ± 8.89 ms; P < .001), shorter QT interval (434.16 ± 32.70 ms vs 462.66 ± 32.04 ms; P < .001), and QTc interval (472.44 ± 33.30 ms vs 499.65 ± 31.35 ms; P < .001), lower QTD (40.10 ± 8.68 ms vs 46.11 ± 10.85 ms; P = .001), and QTc D (43.57 ± 8.78 ms vs 49.86 ± 11.98 ms; P = .001), and shorter Tp Te (96.59 ± 10.76 ms vs 103.77 ± 10.16 ms; P < .001) than RVSP. However, Tp Te /QT ratio did not differ between these two groups (0.223 ± 0.026 vs 0.225 ± 0.022; P = .733). Furthermore, LBBAP displayed less increased QRS duration, QTc interval, QTD, QTc D, and a more shortened QT interval compared with RVSP (all P < .05). CONCLUSION LBBAP proves to be a feasible and safe pacing procedure with better depolarization-repolarization reserve, which may predict lower risk of ventricular arrhythmia and sudden cardiac death.
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Affiliation(s)
- Jingfeng Wang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Xueying Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Jin Bai
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Haiyan Chen
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Medical Imaging, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yangang Su
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Ruizhen Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
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Krzemień-Wolska K, Tomasik A, Nowalany-Kozielska E, Jacheć W. Prognosis of patients with implanted pacemakers in 4‑year follow-up : Impact of right ventricular pacing site. Herz 2018; 43:315-324. [PMID: 28396904 PMCID: PMC5999135 DOI: 10.1007/s00059-017-4561-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 03/08/2017] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pacing remains the method of choice for treatment of cardiac electrical conduction disorders. This study examined the interrelationship between the site of the right ventricular lead tip and patient prognosis in association with other cardiovascular risk factors over a 4‑year follow-up period. PATIENTS AND METHODS The study comprised 450 consecutive patients (223 women; aged 69.16 ± 9.63 years) who had their first SSI or DDD pacemaker implanted for typical indications. RESULTS During follow-up, 91 (20.2%) patients died. The positive prognostic factors were: female sex (hazard ratio [HR] = 0.426), DDD pacemaker (HR = 0.526), oral anticoagulant use (HR = 0.330; all groups), sodium concentration (HR = 0.926), oral anticoagulant (HR = 0.115) and statin (HR = 0.260) use (female group), and non-apical location of the right ventricular lead tip (HR = 0.549; male group). Risk factors for death were: age (HR = 1.063), diabetes requiring insulin (HR = 2.832), creatinine concentration (HR = 1.005; all groups), age (HR = 1.11; female group), and elevated creatinine level (HR = 1.012; male group). In all patients, the non-apical location of the right ventricular lead tip was associated with an 18.92% reduced mortality rate during the 4‑year follow-up, which was statistically significant for the male group. CONCLUSION The non-apical location of the right ventricular lead tip was a positive prognostic factor and was statistically significant in the male subgroup.
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Affiliation(s)
| | - A Tomasik
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland
| | - E Nowalany-Kozielska
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland
| | - W Jacheć
- Szpital Specjalistyczny w Zabrzu, Zabrzu, Poland.
- Second Department of Cardiology, Medical University of Silesia, ul. Skłodowskiej 10, 41-800, Zabrzu, Poland.
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Worsnick SA, Sharma PS, Vijayaraman P. Right Ventricular Septal Pacing: A Paradigm Shift. J Innov Card Rhythm Manag 2018; 9:3137-3146. [PMID: 32494491 PMCID: PMC7252807 DOI: 10.19102/icrm.2018.090501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/27/2017] [Indexed: 11/06/2022] Open
Abstract
The right ventricular (RV) apex has been considered to be the primary site for ventricular lead implantation since the original descriptions of permanent pacing. However, long-term RV apical pacing has been shown to have negative effects on ventricular function and hemodynamics as a result of ventricular dyssynchrony. Alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for patients with a need for long-term ventricular pacing. In this article, we review the available data on the use of these alternative sites for RV pacing.
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Hirayama Y, Kawamura Y, Sato N, Saito T, Tanaka H, Saijo Y, Kikuchi K, Ohori K, Hasebe N. Functional characteristics of left ventricular synchronization via right ventricular outflow-tract pacing detected by two-dimensional strain echocardiography. J Arrhythm 2017; 33:28-34. [PMID: 28217226 PMCID: PMC5300840 DOI: 10.1016/j.joa.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/07/2016] [Accepted: 05/02/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Recently, due to the detrimental effects on the ventricular function associated with right ventricular apical (RVA) pacing, right ventricular septal (RVS) pacing has become the preferred pacing method. However, the term RVS pacing refers to both right ventricular outflow-tract (RVOT) and mid-septal (RVMS) pacing, leading to a misinterpretation of the results of clinical studies. The purpose of this study, therefore, was to elucidate the functional differences of RVA, RVOT, and RVMS pacing in patients with atrioventricular block. METHODS We compared the QRS duration, global longitudinal strain (GLS), and left ventricular (LV) synchronization parameters at the three pacing sites in 47 patients. The peak systolic strain (PSS) time delay between the earliest and latest segments among the 18 LV segments and standard deviation (SD) of the time to the PSS were also calculated for the 18 LV segments at each pacing site using two-dimensional (2D) strain echocardiography. RESULTS RVMS pacing was associated with a significantly shorter QRS duration compared with RVA and RVOT pacing (154.4±21.4 vs 186.5±19.9 and 171.1±21.5 ms, P<0.001). In contrast, RVOT pacing revealed a greater GLS (-14.69±4.92 vs -13.12±4.76 and -13.51±4.81%, P<0.001), shorter PSS time delay between the earliest and latest segments (236.0±87.9 vs 271.3±102.9 and 281.9±126.6%, P=0.007), and shorter SD of the time to the PSS (70.8±23.8 vs 82.7±30.8 and 81.5±33.7 ms, P=0.002) compared with RVA and RVMS pacing. CONCLUSIONS These results suggest that the functional characteristics of RVOT pacing may be a more optimal pacing site than RVMS, regardless of the pacing QRS duration, in patients with atrioventricular conduction disorders.
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Affiliation(s)
- Yasutaka Hirayama
- Division of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Yuichiro Kawamura
- Department of Cardiology, Asahikawa Medical University, Asahikawa Medical University, Midorigaoka Higashi 2-1-1, Asahikawa, 078-8510, Japan
| | - Nobuyuki Sato
- Department of Cardiology, Asahikawa Medical University, Asahikawa Medical University, Midorigaoka Higashi 2-1-1, Asahikawa, 078-8510, Japan
| | - Tatsuya Saito
- Division of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Hideichi Tanaka
- Division of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Yasuaki Saijo
- Division of Community Medicine and Epidemiology, Department of Health Science, Asahikawa Medical University, Midorigaoka Higashi 2-1-1, Asahikawa, 078-8510, Japan
| | - Kenjiro Kikuchi
- Division of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Katsumi Ohori
- Division of Cardiovascular Surgery, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Naoyuki Hasebe
- Department of Cardiology, Asahikawa Medical University, Asahikawa Medical University, Midorigaoka Higashi 2-1-1, Asahikawa, 078-8510, Japan
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Cicchitti V, Radico F, Bianco F, Gallina S, Tonti G, De Caterina R. Heart failure due to right ventricular apical pacing: the importance of flow patterns. Europace 2016; 18:1679-1688. [DOI: 10.1093/europace/euw024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 01/25/2016] [Indexed: 01/12/2023] Open
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Detection of perfusion abnormalities in patients with permanent pacemakers on stress–rest 99mTc-tetrofosmin myocardial perfusion single-photon emission computed tomography. Nucl Med Commun 2016; 37:406-11. [DOI: 10.1097/mnm.0000000000000472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moore P, Coucher J, Ngai S, Stanton T, Wahi S, Gould P, Booth C, Pratap J, Kaye G. Imaging and Right Ventricular Pacing Lead Position: A Comparison of CT, MRI, and Echocardiography. Pacing Clin Electrophysiol 2016; 39:382-92. [PMID: 26769293 DOI: 10.1111/pace.12817] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 01/04/2016] [Accepted: 01/04/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Right ventricular nonapical (RVNA) pacing may reduce the risk of heart failure. Fluoroscopy is the standard approach to determine lead tip position, but is inaccurate. We compared cardiac computed tomography (CT), magnetic resonance imaging (MRI), two-dimensional and three-dimensional transthoracic echocardiography (TTE), and chest x-ray (CXR) to assess which provides the optimal assessment of right ventricular (RV) lead tip position. METHODS Eighteen patients with MRI-conditional pacemakers (10 RVNA and eight apical [RVA] leads) underwent contrast CT, MRI, TTE, and a standard postimplant posteroanterior and lateral CXR. To compare images, the RV was arbitrarily partitioned into three long-axis segments (right ventricular outflow tract, middle, and apex), and two short-axis segments (septal and nonseptal). Agreement between modalities was assessed. RESULTS RV lead tip position was identified in all patients on CT, TTE, and CXR, but was not identified in seven (39%) patients on MRI due to device-related artifact. Of 10 leads deemed to be nonapical/septal during implant, 70% were identified as nonapical on CXR, 60% on CT, 60% on MRI, and 80% on TTE. On CT imaging only 10% were truly septal, 20% on MRI, 30% on CXR, and 80% on TTE. Agreement was better between modalities when assessing position of the designated RVA leads. CONCLUSION During implant leads intended for the septum are not confirmed as such on subsequent imaging, and marked heterogeneity is apparent between modalities. MRI is limited by artifact, and discrepancy exists between TTE and CT in identifying septal lead position. CT gave the clearest definition of lead tip position.
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Affiliation(s)
- Peter Moore
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - John Coucher
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Stanley Ngai
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Tony Stanton
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Sudhir Wahi
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Paul Gould
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Cameron Booth
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jit Pratap
- Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gerald Kaye
- Princess Alexandra Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Kaye G. Pacing site in pacemaker dependency: is right ventricular septal lead position the answer? Expert Rev Cardiovasc Ther 2015; 12:1407-17. [PMID: 25418757 DOI: 10.1586/14779072.2014.979791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The right ventricular apex has been the traditional site for lead placement in patients with atrioventricular block. Pacing at the right ventricular apex may have long-term deleterious effects on left ventricular (LV) function, promoting heart failure and increasing mortality. Pacing at the right ventricular septum has been proposed to minimize deterioration in LV function. Although experimental data suggest that septal pacing protects LV function, clinical studies have provided conflicting results. A recent large study in patients with heart block did not show a protective effect with septal pacing. Other pacing approaches are becoming increasingly relevant; however, prediction of what method should be employed in which patient is not currently possible. Other factors such as baseline LV function and associated co-morbidities impact LV function, irrespective of pacing site. Continued monitoring of cardiac function post-implant is therefore critical to ongoing care. An algorithm for managing patients with atrioventricular block is proposed.
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Affiliation(s)
- Gerry Kaye
- Department of Cardiology, Princess Alexandra Hospital, Woolloongabba and University of Queensland, Brisbane 4102, Australia
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11
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Fang F, Sanderson JE, Yu CM. Should all patients with heart block receive biventricular pacing? All heart block patients with a pacemaker indication should receive biventricular pacing: one move, double the gains? Circ Arrhythm Electrophysiol 2015; 8:722-9. [PMID: 26082528 DOI: 10.1161/circep.114.000626] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fang Fang
- From the Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education and Research Training (HEART) Center, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - John E Sanderson
- From the Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education and Research Training (HEART) Center, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Cheuk-Man Yu
- From the Division of Cardiology, Department of Medicine and Therapeutics, Institute of Vascular Medicine, Institute of Innovative Medicine, Heart Education and Research Training (HEART) Center, Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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Zhang H, Hou X, Wang Y, Xue S, Cao K, Chen J, Zou J. The acute and chronic effects of different right ventricular site pacing on left ventricular mechanical synchrony as assessed by phase analysis of SPECT myocardial perfusion imaging. J Nucl Cardiol 2014; 21:958-66. [PMID: 24872255 DOI: 10.1007/s12350-014-9912-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 03/10/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to assess acute and chronic effects of right ventricular mid-septum (RVS) versus right ventricular apex (RVA) pacing on left ventricular (LV) mechanical dyssynchrony using phase analysis of gated single photon emission computed tomography myocardial perfusion imaging (MPI). METHODS Thirty-nine patients with complete atrioventricular (AV) block, who were indicated for permanent pacing, were recruited and randomized to receive RVA (n = 20) or RVS (n = 19) pacing. All patients underwent MPI at 1 week and 6 months after pacemaker implantation. LV dyssynchrony and cardiac function were assessed by MPI and compared between the two groups. RESULTS There were no significant differences in baseline characteristics between the RVS and RVA groups. The paced QRS duration was significantly longer in the RVA group than in the RVS group. LV dyssynchrony parameters were not significantly different between the groups at the 1-week follow-up, but they were significantly smaller in the RVS group than in the RVA group at the 6-month follow-up. LV dyssynchrony parameters significantly decreased in the RVS group from the 1-week follow-up to the 6-month follow-up, but were unchanged in the RVA group. No differences in LV function parameters were observed between the groups at the 1-week and 6-month follow-ups. CONCLUSIONS RVS pacing produces better electrical and mechanical synchrony than RVA pacing for patients with complete AV block.
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Affiliation(s)
- Hongxiang Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China,
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Akerström F, Pachón M, Puchol A, Jiménez-López J, Segovia D, Rodríguez-Padial L, Arias MA. Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them. Int J Cardiol 2014; 173:351-60. [PMID: 24721486 DOI: 10.1016/j.ijcard.2014.03.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023]
Abstract
The permanent cardiac pacemaker is the only effective therapy for patients with symptomatic bradycardia and hundreds of millions are implanted worldwide every year. Despite its undisputed clinical benefits, the last two decades have drawn much attention to the negative effects associated with long-term pacing of the right ventricle (RV). Experimental and clinical studies have shown that RV pacing produces ventricular dyssynchrony, similar to that of left bundle branch block, with consequent detrimental effects on cardiac structure and function, with adverse clinical outcomes such as atrial fibrillation, heart failure and death. Although clinical evidence largely comes from subanalyses of pacemaker and implantable cardiac defibrillator studies, there is strong evidence that patients with reduced left ventricular function are at high risk of suffering from the detrimental effects of long-term RV pacing. Biventricular pacing in cardiac resynchronization therapy devices can prevent ventricular dyssynchrony and has emerged as an attractive option in this patient group with promising results and more clinical studies underway. Moreover, there is evidence that specific pacemaker algorithms that minimize RV pacing can reduce the negative effects of RV stimulation on cardiac function and may also prevent clinical deterioration. The extent of the long-term clinical effects of RV pacing in patients with normal ventricular function and how to prevent this are less clear and subject to future investigation.
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Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Jesús Jiménez-López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Diana Segovia
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis Rodríguez-Padial
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
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Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing. J Interv Card Electrophysiol 2014; 40:81-6. [DOI: 10.1007/s10840-014-9878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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15
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Akerström F, Arias MA, Pachón M, Jiménez-López J, Puchol A, Juliá-Calvo J. The importance of avoiding unnecessary right ventricular pacing in clinical practice. World J Cardiol 2013; 5:410-419. [PMID: 24340139 PMCID: PMC3857233 DOI: 10.4330/wjc.v5.i11.410] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/20/2013] [Accepted: 10/12/2013] [Indexed: 02/06/2023] Open
Abstract
Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with long-term pacing of the apex of the right ventricle (RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function (LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing (cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.
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16
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Vančura V, Wichterle D, Melenovský V, Kautzner J. Assessment of optimal right ventricular pacing site using invasive measurement of left ventricular systolic and diastolic function. ACTA ACUST UNITED AC 2013; 15:1482-90. [DOI: 10.1093/europace/eut068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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Mazza A, Bendini MG, Leggio M, Riva U, Ciardiello C, Valsecchi S, De Cristofaro R, Giordano G. Incidence and predictors of heart failure hospitalization and death in permanent pacemaker patients: a single-centre experience over medium-term follow-up. Europace 2013; 15:1267-72. [DOI: 10.1093/europace/eut041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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18
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Weizong W, Zhongsu W, Yujiao Z, Mei G, Jiangrong W, Yong Z, Xinxing X, Yinglong H. Effects of right ventricular nonapical pacing on cardiac function: a meta-analysis of randomized controlled trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1032-51. [PMID: 23438131 DOI: 10.1111/pace.12112] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 12/18/2012] [Accepted: 01/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effects of right ventricular nonapical (RVNA) and right ventricular apical (RVA) pacing on cardiac function. METHODS A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Library to identify RCTs comparing RVNA pacing with RVA pacing with follow-up ≥2 months. Twenty RCTs involving 1,114 patients were included. RESULTS Compared with RVA pacing, RVNA (mainly right ventricular septum [RVS]) pacing exhibited not only excellent pacing threshold and R-wave amplitude but also higher impedance. RVNA pacing showed a significant increase in left ventricular ejection fraction (LVEF) at the end of follow-up (weighted mean difference = 3.58, 95% confidence interval = 1.80-5.35), and the effects were observed in the following subgroups: 6-month follow-up, ≤12-month follow-up, >12-month follow-up, baseline LVEF ≤45%, and baseline LVEF >45%. RVS and RVA pacing significantly differed in improving LVEF (weighted mean difference = 4.82, 95% confidence interval = 2.78-6.87). In addition, RVNA pacing resulted in a narrower QRS duration, a smaller left ventricular end-systolic volume, and a lower New York Heart Association functional class. CONCLUSIONS This meta-analysis found that RVNA (mainly RVS) pacing exhibited satisfactory long-term lead performance compared with RVA pacing and demonstrated beneficial effects in improving LVEF after the 6-month follow-up. Furthermore, it proved superior to RVA pacing in terms of interventricular synchrony and cardiac function.
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Affiliation(s)
- Wang Weizong
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan City, China
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19
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Domenichini G, Sunthorn H, Fleury E, Foulkes H, Stettler C, Burri H. Pacing of the interventricular septum versus the right ventricular apex: a prospective, randomized study. Eur J Intern Med 2012; 23:621-7. [PMID: 22939807 DOI: 10.1016/j.ejim.2012.03.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 03/11/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Left ventricular (LV) function may be impaired by right ventricular (RV) apical pacing. The interventricular septum is an alternative pacing site, but randomized data are limited. Our aim was to compare ejection fraction (EF) resulting from pacing the interventricular septum versus the RV apex. METHODS RV lead implantation was randomized to the apex or the mid-septum. LVEF and RVEF were determined at baseline and after 1 and 4 years by radionuclide angiography. RESULTS We enrolled 59 patients, of whom 28 were randomized to the apical group and 31 to the septal group, with follow-up available in 47 patients at 1 year and 33 patients at 4 years. LVEF in the apical and in the septal groups was 55 ± 8% vs. 46 ± 15% (p=0.021) at 1 year and 53 ± 12% vs. 47 ± 15% (p=0.20) at 4 years. Echocardiography confirmed a mid-septal lead position in only 54% of patients in the septal group, with an anterior position in the remaining patients. In the septal group, LVEF decreased significantly in patients with an anterior RV lead (-10.0 ± 7.7%, p=0.003 at 1 year and -8.0 ± 9.5%, p=0.035 at 4 years), but not in patients who had a mid-septal lead. Left intraventricular dyssynchrony was significantly increased in case of an anterior RV lead. RVEF was not significantly impaired by RV pacing, regardless of RV lead position. CONCLUSIONS Pacing at the RV septum confers no advantage in terms of ventricular function compared to the apex. Furthermore, inadvertent placement of the RV lead in an anterior position instead of the mid-septum results in reduced LV function.
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Yusu S, Mera H, Hoshida K, Miyakoshi M, Miwa Y, Tsukada T, Yoshino H, Ikeda T. Selective site pacing from the right ventricular mid-septum. Follow-up of lead performance and procedure technique. Int Heart J 2012; 53:113-6. [PMID: 22688315 DOI: 10.1536/ihj.53.113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied. A screw-in lead and a curved stylet were used for lead positioning on the RV mid-septum. Pacemaker indices were evaluated at implantation and one year later. As an electrocardiographic parameter, QRS duration was measured in lead II. These data were compared to those of 66 patients subjected to conventional RV apical pacing. Lead placement was successful in all patients of RV mid-septal pacing. There were no technical problems during or after the procedure. The cumulative percentage of ventricular pacing at one year postimplantation was 85 ± 24 % in the SSP group. Sensing, pacing threshold, and lead impedance in the SSP group remained clinically stable over one year. When these measurements were compared between the SSP and AP groups, the pacing threshold and the lead impedance at one year postimplantation in the SSP group were higher (P < 0.05) and lower (P < 0.01), respectively, than those of the AP group. The mean QRS duration was markedly shorter (123 ± 16 versus 150 ± 18 msec, P < 0.0001). Selective site pacing from the RV mid-septum is feasible and results in less conduction delay compared to conventional RV apical pacing, and its procedure seems to be more physiological in permanent pacemaker implantation.
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Affiliation(s)
- Satoru Yusu
- Second Department of Internal Medicine, Kyorin University School of Medicine, Japan
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21
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Accuracy of Fluoroscopic and Electrocardiographic Criteria for Pacemaker Lead Implantation by Comparison with Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2012; 25:796-803. [DOI: 10.1016/j.echo.2012.04.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Indexed: 12/20/2022]
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22
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Corcoran SJ, Davis LM. Cardiac Implantable Electronic Device Therapy for Bradyarrhythmias and Tachyarrhythmias. Heart Lung Circ 2012; 21:328-37. [DOI: 10.1016/j.hlc.2012.03.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 03/12/2012] [Accepted: 03/14/2012] [Indexed: 11/27/2022]
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Right Ventricular Pacing, Mechanical Dyssynchrony, and Heart Failure. J Cardiovasc Transl Res 2011; 5:219-31. [DOI: 10.1007/s12265-011-9341-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 12/11/2011] [Indexed: 11/25/2022]
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24
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Shimony A, Eisenberg MJ, Filion KB, Amit G. Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. Europace 2011; 14:81-91. [PMID: 21798880 DOI: 10.1093/europace/eur240] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Previous studies have suggested that right ventricular apical (RVA) pacing may have deleterious effects on left ventricular function. Whether right ventricular non-apical (RVNA) pacing offers a better alternative to RVA pacing is unclear. We aimed to conduct a systematic review and meta-analysis of randomized-controlled trials (RCTs) in order to compare the mid- and long-term effects of RVA and RVNA pacing. METHODS AND RESULTS We systematically searched the Cochrane library, EMBASE, and MEDLINE databases for RCTs comparing RVA with RVNA pacing over >2 months follow-up. Data were pooled using random-effects models. Fourteen RCTs met our inclusion criteria involving 754 patients. Compared with subjects randomized to RVA pacing, those randomized to RVNA pacing had greater left ventricular ejection fractions (LVEF) at the end of follow-up [13 RCTs: weighted mean difference (WMD) 4.27%, 95% confidence interval (CI) 1.15%, 7.40%]. RVNA had a better LVEF at the end of follow-up in RCTs with follow-up ≥12 months (WMD 7.53%, 95% CI 2.79%, 12.27%), those with <12 months of follow-up (WMD 1.95%, 95% CI 0.17%, 3.72%), and those conducted in patients with baseline LVEF ≤40-45% (WMD 3.71%, 95% CI 0.72%, 6.70%); no significant difference was observed in RCTs of patients whose baseline LVEF was preserved. Randomized-controlled trials provided inconclusive results with respect to exercise capacity, functional class, quality of life, and survival. CONCLUSIONS While RCTs suggest that LVEF is higher with RVNA than with RVA pacing, there remains a need for large RCTs to compare the safety and efficacy of RVNA and RVA pacing.
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Affiliation(s)
- Avi Shimony
- Division of Cardiology, Jewish General Hospital, Lady Davis Institute for Medical Research, McGill University, 5790 Cote-des-Neiges Road/Suite H-453, Montreal, Quebec, Canada H3S 1Y9.
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25
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Right ventricular septal pacing. COR ET VASA 2011. [DOI: 10.33678/cor.2011.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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26
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Inoue K, Okayama H, Nishimura K, Saito M, Yoshii T, Hiasa G, Sumimoto T, Inaba S, Suzuki J, Ogimoto A, Funada JI, Higaki J. Right ventricular septal pacing preserves global left ventricular longitudinal function in comparison with apical pacing: analysis of speckle tracking echocardiography. Circ J 2011; 75:1609-15. [PMID: 21597204 DOI: 10.1253/circj.cj-10-1138] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Right ventricular (RV) pacing alters left ventricular (LV) mechanical activation, resulting in adverse impacts on LV function. This study was aimed to investigate the acute effect of RV apical (RVA) and septal pacing (RVS) on LV dyssynchrony and function using speckle tracking echocardiography. METHODS AND RESULTS The 103 patients (749 years) with symptomatic bradyarrhythmia and preserved LV ejection fraction, and 50 age-matched control subjects were studied. All patients received a permanent pacemaker and were randomly assigned into 2 groups (RVA: n = 51, RVS: n = 52). After insertion, patients underwent an echocardiographic study during RV pacing. LV dyssynchrony and global strain parameters were analyzed using speckle tracking echocardiography. The QRS width and dyssynchrony indices by longitudinal and radial strain were significantly greater in RVA than in both the control and RVS. The LV longitudinal dyssynchrony index was significantly related to global longitudinal strain (GLS) among 103 patients receiving RV pacing (R² = 0.25, P < 0.0001). The GLS in RVA were the lowest among the 3 groups (GLS: CONTROL -18.22.4%, RVA: -14.33.1%, P < 0.001 vs. control, RVS: -16.82.7%, P<0.01 vs. RVA). CONCLUSIONS RVA created heterogeneous LV contraction, which resulted in deteriorated LV longitudinal contraction. RVS could be a better pacing alternative in terms of less LV dyssynchrony and better longitudinal function compared to RVA.
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Affiliation(s)
- Katsuji Inoue
- Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Japan
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Rubaj A, Rucinski P, Sodolski T, Bilan A, Gulaj M, Dabrowska-Kugacka A, Kutarski A. Comparison of the acute hemodynamic effect of right ventricular apex, outflow tract, and dual-site right ventricular pacing. Ann Noninvasive Electrocardiol 2011; 15:353-9. [PMID: 20946558 DOI: 10.1111/j.1542-474x.2010.00391.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND We studied the acute effect of pacing at the right ventricular outflow tract (RVOT), right ventricular apex (RVA) and simultaneous RVA and RVOT-dual-site right ventricular pacing (DuRV) in random order on systolic function using impedance cardiography. METHODS Seventy-three patients (46 males), aged 52-89 years (mean 71.4 years) subjected to routine dual chamber pacemaker implantation with symptomatic chronic II or atrioventricular block, were included to the study. RESULTS DuRV pacing resulted in significantly higher cardiac index (CI) in comparison to RVOT and RVA and CI at RVOT was higher than at RVA pacing (2.46 vs 2.35 vs 2.28; P < 0.001). In patients with ejection fraction >50% significantly higher CI was observed during DuRV pacing when compared to RVOT and RVA pacing and there was no difference of CI between RVOT and RVA pacing (2.53 vs 2.41 vs 2.37; P < 0.001). In patients with ejection fraction <50%, DuRV and RVOT pacing resulted in significantly higher CI in comparison to RVA pacing while no difference in CI was observed between RVOT and DuRV pacing (2.28 vs 2.21 vs 2.09; P < 0.001). CONCLUSION Dual-site right ventricular pacing in comparison to RVA pacing improved cardiac systolic function. RVOT appeared to be more advantageous than RVA pacing in patients with impaired, but not in those with preserved left ventricular function. No clear hemodynamic benefit of DuRV in comparison to RVOT pacing in patients with impaired systolic function was observed.
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Affiliation(s)
- Andrzej Rubaj
- Department of Cardiology, Medical University of Lublin, Poland
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Kohno R, Abe H, Oginosawa Y, Tamura M, Takeuchi M, Nagatomo T, Otsuji Y. Reliability and Characteristics of Atrial Tachyarrhythmias Detection in Dual Chamber Pacemakers. Circ J 2011; 75:1090-7. [DOI: 10.1253/circj.cj-10-0896] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ritsuko Kohno
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Yasushi Oginosawa
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masahito Tamura
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Masaaki Takeuchi
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Toshihisa Nagatomo
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
| | - Yutaka Otsuji
- The Second Department of Internal Medicine, University of Occupational and Environmental Health, Japan
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Kalahasty G, Ellenbogen KA. Selection of Ventricular Pacing Sites Guided by Echocardiography: An Electrophysiologist's Perspective. J Am Soc Echocardiogr 2010; 23:608-10. [DOI: 10.1016/j.echo.2010.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Sancho-Tello de Carranza MJ, Martínez-Ferrer J, Pombo-Jiménez M, de Juan-Montiel J. [Progress in cardiac pacing]. Rev Esp Cardiol 2010; 63 Suppl 1:73-85. [PMID: 20223181 DOI: 10.1016/s0300-8932(10)70142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This review discusses the utility and current status of remote monitoring in patients with cardiac devices in Spain, the different anticoagulation strategies used during device implantation, the surgical replacement and maintenance of pacemakers and defibrillators, and the present and future importance of impedance sensors in cardiac pacing and heart failure management. Finally, there is a summary of the most relevant scientific articles published in the last year.
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