Effect of chronic right ventricular apical pacing on left ventricular function

O’Keefe, James H.; Abuissa, Hussam; Jones, Philip G.; Thompson, Randall C.; Bateman, Timothy M.; McGhie, A. Iain; Ramza, Brian; Steinhaus, David

doi:10.1016/j.amjcard.2004.11.034

Cited by 108 publications

(73 citation statements)

References 13 publications

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“…However, several studies performed over the last decade have demonstrated that conventional long‐term RV apical pacing can increase the risk of death and heart failure hospitalization 4, 5, 6. It is well known that long‐term RV apical pacing produces wide QRS duration (QRSd), left ventricular (LV) dyssynchrony, hemodynamic impairment, negative inotropy, and LV diastolic and systolic dysfunction in a subgroup of pacer‐dependent patients 4, 7, 8. Thus, other pacing sites as an alternative to RV apical pacing have been explored, although clinical benefits from alternative pacing sites are still inconclusive 9, 10…”

Section: Introductionmentioning

confidence: 99%

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Huang

et al. 2017

JAHA

191

122

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BackgroundClinical benefits from His bundle pacing (HBP) in heart failure patients with preserved and reduced left ventricular ejection fraction are still inconclusive. This study evaluated clinical outcomes of permanent HBP in atrial fibrillation patients with narrow QRS who underwent atrioventricular node ablation for heart failure symptoms despite rate control by medication.Methods and ResultsThe study enrolled 52 consecutive heart failure patients who underwent attempted atrioventricular node ablation and HBP for symptomatic atrial fibrillation. Echocardiographic left ventricular ejection fraction and left ventricular end‐diastolic dimension, New York Heart Association classification and use of diuretics for heart failure were assessed during follow‐up visits after permanent HBP. Of 52 patients, 42 patients (80.8%) received permanent HBP and atrioventricular node ablation with a median 20‐month follow‐up. There was no significant change between native and paced QRS duration (107.1±25.8 versus 105.3±23.9 milliseconds, P=0.07). Left ventricular end‐diastolic dimension decreased from the baseline (P<0.001), and left ventricular ejection fraction increased from baseline (P<0.001) in patients with a greater improvement in heart failure with reduced ejection fraction patients (N=20) than in heart failure with preserved ejection fraction patients (N=22). New York Heart Association classification improved from a baseline 2.9±0.6 to 1.4±0.4 after HBP in heart failure with reduced ejection fraction patients and from a baseline 2.7±0.6 to 1.4±0.5 after HBP in heart failure with preserved ejection fraction patients. After 1 year of HBP, the numbers of patients who used diuretics for heart failure decreased significantly (P<0.001) when compared to the baseline diuretics use.ConclusionsPermanent HBP post–atrioventricular node ablation significantly improved echocardiographic measurements and New York Heart Association classification and reduced diuretics use for heart failure management in atrial fibrillation patients with narrow QRS who suffered from heart failure with preserved or reduced ejection fraction.

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Section: Introductionmentioning

confidence: 99%

Benefits of Permanent His Bundle Pacing Combined With Atrioventricular Node Ablation in Atrial Fibrillation Patients With Heart Failure With Both Preserved and Reduced Left Ventricular Ejection Fraction

Huang

et al. 2017

JAHA

191

122

View full text Add to dashboard Cite

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“…It is widely recognized that long-lasting pacing treatment with a high incidence of RV apical stimulation can reduce the haemodynamic performance and increase the risk of atrial fibrillation and heart failure [2][3][4][5][6][7] . Although the mechanisms involved in pacing-related damage are not fully understood, it is conceivable that functional and structural deterioration could result from the increased myocardial stress induced by ventricular desynchronization 10,18 .…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have reported alterations in systolic and diastolic function associated with chronic apical pacing [2][3][4] , which could explain the increased incidence of atrial fibrillation and heart failure in long-term paced patients [5][6][7] . Milder effects on ventricular synchronization and pump function have been associated with right ventricular (RV) pacing applied in alternative sites, like the mid-septum or the outflow tract 2,[8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

Acute effects of right ventricular pacing on cardiac haemodynamics and transvalvular impedance

Táborský¹,

Fedorco²,

Škála³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims.To assess the acute side-effects of right ventricular (RV) stimulation applied in apex and mid-septum, in order to establish the optimal lead location in clinical practice. Methods. During pacemaker implantation, the ventricular lead was temporarily fixed in the apex and then moved to mid-septum. In both positions, surface and endocardial electrograms and transvalvular impedance (32 cases), left ventricular (LV) pressure (23), and transthoracic echocardiography (10) were acquired with intrinsic activity and VDD pacing. Results. A larger increase in QRS duration was noticed with apical than septal pacing (65 ± 25 vs. 45 ± 29 ms; P<10 -4 ). The proportion of cases where RV stimulation affected the transvalvular impedance waveform was higher with apical lead location (56% vs. 20%; P<0.02). VDD pacing at either site reduced the maximum dP/dt by 6% with respect to intrinsic AV conduction (IAVC; P<0.005). The maximum pressure drop taking place in 100 ms was reduced by 6 and 8%, respectively, with apical and septal pacing (P<0.01 vs. IAVC). Apical VDD decreased mitral annulus velocity in early diastole (E') from 7.5 ± 1.4 to 5.9 ± 0.9 cm/s (P<0.02) and prolonged the E-wave deceleration time (DT) from 156 ± 33 to 199 ± 54 ms (P<0.02), while septal pacing induced non-significant modifications in E' and DT. Conclusion. Ventricular stimulation acutely impairs LV systolic and diastolic performance, independent of the pacing site. Septal lead location preserves RV contraction mechanics and reduces the electrical interventricular delay.

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“…RV pacing has been shown to improve symptoms, exercise capacity, quality of life and survival in these patients (Gammage et al 1991;Lamas et al 1995;Sweeney et al 2007). However, permanent RV pacing has been associated with an increased risk of LV dysfunction, hospitalization, HF, and death (Hayes et al 2006;Lieberman et al 2006;O'Keefe et al 2005;Sweeney et al 2003;Tse and Lau 1997;Wilkoff et al 2002). In 2002, the results of the DAVID trial revealed that RV paced patients with LV dysfunction, requiring a defibrillator, who were actively paced in DDDR-70 mode had a 60% greater risk for hospitalization or death than patients who received minimal back-up pacing in VVI-40 mode (Wilkoff et al 2002).…”

Section: Effects Of Rv Pacingmentioning

confidence: 99%