Right ventricular outflow pacing induces less regional wall motion abnormalities in the left ventricle compared with apical pacing

Wang, Fang; Shi, Huidong; Sun, Yaping; Wang, Jufang; Yan, Qing; Jin, Wei; Zhang, Jianjun; Meng, Weidong; Zhang, Feng; Chen, Gang; Sun, Baogui

doi:10.1093/europace/eur309

Cited by 28 publications

(40 citation statements)

References 22 publications

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“…Furthermore, a number of evidences indicate that the myocardial desynchronization is proportional to the QRSd. In addition, recent observations corroborate less desynchrony of the LV with septal pacing [22].…”

Section: Qrs Duration (Qrsd)mentioning

confidence: 60%

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

Mateos¹,

Mateos²,

Vargas³

et al. 2012

Rev Bras Cir Cardiovasc

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Comparação de parâmetros eletrofisiológicos das estimulações cardíacas endocárdicas septal e apicalComparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation Abstract Background: The conventional right ventricle (RV) endocardial pacing leads QRS widening and myocardial desynchronization compromising ventricular function. With the need for less deleterious stimulation, RV septal pacing has been used more. Eventually have been reported higher thresholds and smaller R waves in the septal stimulation.Objective: To compare the parameters of the septal and apical stimulation, intra-patient, if there are any differences that may affect the choice of the point of stimulation.Methods: A prospective controlled study. We included 25 patients, 67.2±9 years, 10 (40%) women with indications for pacemaker for bradyarrhythmias. Etiologies were degenerative in nine (36%), Coronary disease in eight (32%), Chagas disease in seven (28%), and valve disease in one (4%) patient. Electrodes were active fixation and assessed the thresholds of command, impedance and R wave in uniand bipolar implant and after six months. Rev Bras Cir Cardiovasc 2012;27(2):195-202 Results

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Section: Qrs Duration (Qrsd)mentioning

confidence: 60%

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

Mateos¹,

Mateos²,

Vargas³

et al. 2012

Rev Bras Cir Cardiovasc

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“…In contrast, smaller effects of the pacing site were noticed on LV haemodynamics, which is quite sensitive to the intraventricular desynchronization. It is noteworthy that, in recent studies, pacing at the midseptum 10 or outflow tract 24 reduced interventricular and longitudinal LV desynchronization, without significant improvements in septal-posterior and septal-lateral wall motion delays. Most reports showing that LV function was better preserved by non-apical RV stimulation refer to chronic pacing 2,9,18 .…”

Section: Interventricular Versus Intraventricular Desynchronizationmentioning

confidence: 95%

“…Acute studies yielding positive results 10,13 were performed with lead location criteria, pacing mode and duration, or AV delay setting different from the conditions applied in the present investigation, so that a comparison of the outcomes could be misleading. Moreover, the role of the pacing site in the development of LV haemodynamic dysfunction was not confirmed in some instances 22,[24][25][26] . In contrast, the relevance of alternative site pacing to the interventricular electrical synchronization, as expressed by QRS duration, is well established and further strengthened by the present results.…”

Section: Interventricular Versus Intraventricular Desynchronizationmentioning

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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“…At one time, high hopes were placed on alternative sites of RV pacing, for example, pacing in the RV outflow tract rather than the apex, but results of the studies were discouraging. [76][77][78][79][80][81] The long-term effects of pacing RV sites (outflow tract or septum) other than the apex are unknown. Direct His bundle and paraHisian pacing are generally not applicable to patients with AV block.…”

Section: (1) Risk Versus Benefitmentioning

confidence: 99%

The Role of Biventricular Pacing in the Prevention and Therapy of Pacemaker‐Induced Cardiomyopathy

Guglin

Barold

2015

Noninvasive Electrocardiol

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Right ventricular (RV) pacing produces well-known long-term deleterious effects not only on already compromised, but also on the normal left ventricle (LV). The activation pattern mimicks that of left bundle branch block, with delayed activation of the LV free wall, and results in electrical and mechanical dyssynchrony. Long-term mandatory (100%) RV pacing, increases LV dimensions and decreases the ejection fraction. Many of these negative effects of pacing can be overcome by biventricular pacing. In this review, we describe the characteristics of pacemaker-induced cardiomyopathy, its incidence, and the use of cardiac resynchronization therapy (CRT) for its therapy and prevention. The gaps in the current organizational guidelines for using CRT in the treatment of bradycardia are identified, and goals for future research are discussed.

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Right ventricular outflow pacing induces less regional wall motion abnormalities in the left ventricle compared with apical pacing

Cited by 28 publications

References 22 publications

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

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

The Role of Biventricular Pacing in the Prevention and Therapy of Pacemaker‐Induced Cardiomyopathy

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