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Heart Rhythm. 2014 Apr;11(4):602-8. doi: 10.1016/j.hrthm.2013.12.020. Epub 2013 Dec 11.

Right ventricular apical pacing-induced left ventricular dyssynchrony is associated with a subsequent decline in ejection fraction.

Author information

1
Heart, Lung and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
2
Heart, Lung and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: schwartzmand@upmc.edu.

Abstract

BACKGROUND:

In patients with normal left ventricular (LV) ejection fraction (EF), the interposition of chronic, high-dose right ventricular apical (RVA) pacing may produce late EF decline.

OBJECTIVE:

To test the hypothesis that LV dyssynchrony, defined echocardiographically and apparent early after interposition of pacing, would be greater in patients who subsequently demonstrated EF decline.

METHODS:

Ninety-one patients with normal prepacing EF who underwent atrioventricular node ablation and subsequent high-dose RVA pacing were studied. Transthoracic echocardiograms were performed early (median 4 months) and late (median 28 months) after interposition of pacing, with a significant decline in EF between these studies defined as ≥5%. Speckle-tracking longitudinal strain analysis of the early echocardiogram was performed to quantify dyssynchrony. In addition to standard dyssynchrony indices, a novel index of apex-to-base mechanical propagation delay (MPD) was used.

RESULTS:

Multivariable analysis determined that MPD of the septum correlated with a significant decline in EF, independent of all other dyssynchrony, clinical, or pacing variables. A septal MPD value exceeding 50 ms was associated with EF decline at 81% sensitivity and 88% specificity.

CONCLUSIONS:

Dyssynchrony, in particular septal MPD, measured early after interposition of high-dose RVA pacing predicted a significant late decline in EF in patients who had normal prepacing EF.

KEYWORDS:

Atrial fibrillation; Dyssynchrony; Echocardiography; Heart failure; Pacemakers

PMID:
24333287
DOI:
10.1016/j.hrthm.2013.12.020
[Indexed for MEDLINE]

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