UZH-Logo

Altered left ventricular contraction pattern during right ventricular pacing: assessment using real-time three-dimensional echocardiography


Wolber, T; Haegeli, L; Huerlimann, D; Brunckhorst, C; Lüscher, T F; Duru, F (2011). Altered left ventricular contraction pattern during right ventricular pacing: assessment using real-time three-dimensional echocardiography. Pacing and Clinical Electrophysiology : PACE, 34(1):76-81.

Abstract

Background:  Chronic right ventricular apical (RVA) pacing has been associated with increased risk of heart failure and adverse outcome. The acute effects of RVA pacing on three-dimensional (3D) ventricular function and mechanical dyssynchrony are not well known. We performed a real-time 3D echocardiographic (RT3DE) study to assess global and regional left ventricular function during RVA pacing. Methods:  Twenty-six patients with implanted cardiac devices and normal intrinsic atrioventricular conduction were included in the study. RT3DE was performed during intrinsic sinus rhythm and during RVA pacing. Quantification of global and regional left ventricular function was performed offline by time-volume analysis of 16 myocardial segments. Time to reach minimum regional volume was calculated for each segment as a percentage of the cardiac cycle. The systolic dyssynchrony index (SDI) was defined as the standard deviation of these time periods. Longitudinal function was assessed by time-volume analysis of apical, midventricular, and basal segments. Results:  During RVA pacing, a reversed apical-to-basal longitudinal contraction sequence was observed in 58% of all patients. RVA pacing was associated with increased left ventricular (LV) dyssynchrony (SDI increase from 4.4 ± 2.2% to 6.3 ± 2.4%, P = 0.001) and reduced LV ejection fraction (decrease from 53 ± 13% to 47 ± 14%, P = 0.05). Conclusion:  RT3DE assessment of LV function provides evidence that pacing from the RVA results in acute alterations in LV contraction sequence and increased LV dyssynchrony. Further studies are warranted to assess the potential of RT3DE to identify patients who might be at increased risk of pacing-induced heart failure or who might benefit from alternate-site or multisite pacing. (PACE 2011; 76-81).

Background:  Chronic right ventricular apical (RVA) pacing has been associated with increased risk of heart failure and adverse outcome. The acute effects of RVA pacing on three-dimensional (3D) ventricular function and mechanical dyssynchrony are not well known. We performed a real-time 3D echocardiographic (RT3DE) study to assess global and regional left ventricular function during RVA pacing. Methods:  Twenty-six patients with implanted cardiac devices and normal intrinsic atrioventricular conduction were included in the study. RT3DE was performed during intrinsic sinus rhythm and during RVA pacing. Quantification of global and regional left ventricular function was performed offline by time-volume analysis of 16 myocardial segments. Time to reach minimum regional volume was calculated for each segment as a percentage of the cardiac cycle. The systolic dyssynchrony index (SDI) was defined as the standard deviation of these time periods. Longitudinal function was assessed by time-volume analysis of apical, midventricular, and basal segments. Results:  During RVA pacing, a reversed apical-to-basal longitudinal contraction sequence was observed in 58% of all patients. RVA pacing was associated with increased left ventricular (LV) dyssynchrony (SDI increase from 4.4 ± 2.2% to 6.3 ± 2.4%, P = 0.001) and reduced LV ejection fraction (decrease from 53 ± 13% to 47 ± 14%, P = 0.05). Conclusion:  RT3DE assessment of LV function provides evidence that pacing from the RVA results in acute alterations in LV contraction sequence and increased LV dyssynchrony. Further studies are warranted to assess the potential of RT3DE to identify patients who might be at increased risk of pacing-induced heart failure or who might benefit from alternate-site or multisite pacing. (PACE 2011; 76-81).

Citations

3 citations in Web of Science®
4 citations in Scopus®
Google Scholar™

Altmetrics

Downloads

23 downloads since deposited on 09 Mar 2011
8 downloads since 12 months
Detailed statistics

Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Cardiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2011
Deposited On:09 Mar 2011 11:31
Last Modified:05 Apr 2016 14:37
Publisher:Wiley-Blackwell
ISSN:0147-8389
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:10.1111/j.1540-8159.2010.02908.x
PubMed ID:20946287
Permanent URL: http://doi.org/10.5167/uzh-42780

Download

[img]
Preview
Content: Accepted Version
Filetype: PDF
Size: 1MB
View at publisher

TrendTerms

TrendTerms displays relevant terms of the abstract of this publication and related documents on a map. The terms and their relations were extracted from ZORA using word statistics. Their timelines are taken from ZORA as well. The bubble size of a term is proportional to the number of documents where the term occurs. Red, orange, yellow and green colors are used for terms that occur in the current document; red indicates high interlinkedness of a term with other terms, orange, yellow and green decreasing interlinkedness. Blue is used for terms that have a relation with the terms in this document, but occur in other documents.
You can navigate and zoom the map. Mouse-hovering a term displays its timeline, clicking it yields the associated documents.

Author Collaborations