Long-Term Nonoutflow Septal Versus Apical Right Ventricular Pacing: Relation to Left Ventricular Dyssynchrony

Autor:	Angelos G. Rigopoulos, Panayota Flevari, Ioannis Paraskevaidis, Katerina Fountoulaki, Dionyssios Leftheriotis, F. Panou, Dimitrios Th. Kremastinos
Rok vydání:	2009
Předmět:	Male medicine.medical_specialty Cardiac pacing Heart Ventricles Doppler imaging Ventricular Outflow Obstruction Ventricular Dysfunction Left Internal medicine Heart Septum Humans Medicine In patient Longitudinal Studies Ventricular dyssynchrony Aged Ejection fraction business.industry Cardiac Pacing Artificial General Medicine Ventricular pacing medicine.disease Heart septum Treatment Outcome Lv dyssynchrony Cardiology Female Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 32:354-362
ISSN:	1540-8159 0147-8389
DOI:	10.1111/j.1540-8159.2008.02244.x
Popis:	Background: Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF. Methods: In thirty-six patients with atrioventricular (AV) block, a dual-chamber pacemaker was implanted. The ventricular electrode was placed either at the apex or at the lower septum, in a randomized sequence. Twenty-four to 48 hours following implantation, we measured LV volumes, EF, and LV dyssynchrony (by tissue Doppler imaging), both with and without pacing. Patients were reassessed echocardiographically after 12 months. Results: Lower septal pacing induced a more synchronized pattern of LV contraction changes (P < 0.05). Following 12 months, differences were observed between groups regarding LV volumes and EF. EF increased within the septal group (from 52 ± 3.3% to 59 ± 3.0%, P < 0.05). A significant inverse relation was documented between changes in LV dyssynchrony and changes in EF (r =−0.64, P < 0.05). Conclusions: In patients with AV block, RV nonoutflow septal pacing represents an attractive alternative, since it preserves better and may even improve LV volumes and EF. Late changes in EF are associated with the changes in LV dyssynchrony imposed by pacing.
Databáze:	OpenAIRE
Externí odkaz:	https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d13060ee78711db0ad5a71af677d66bc https://doi.org/10.1111/j.1540-8159.2008.02244.x Zobrazit plný text záznamu Plný text ve formátu PDF Plný text ve formátu HTML
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