Septal pacing preserving better left ventricular mechanical performance and contractile synchronism than apical pacing in patients implanted with an atrioventricular sequential dual chamber pacemaker

Chih Chieh Yu, Yen Bin Liu, Mao Shin Lin, Jen Yu Wang, Jiunn Lee Lin, Lung Chun Lin

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Permanent pacing is the treatment for chronotropically incompetent hearts. However, the right ventricular (RV) apical pacing-induced asynchrony, even maintaining the atrioventricular (AV) sequential activation, has depressed left ventricular contractility. Whether RV septal pacing would less compromise the electromechanical performance of the left ventricle and the chronotropic effect on myocardial contractility, is unknown. Methods: We prospectively studied 42 patients without structural heart diseases and with symptomatic bradycardia. There were 10 patients receiving atrial pacing (AAI) pacemakers, 18 patients having AV sequential pacing at RV apex (DDDapx) and 14 patients being AV sequentially paced at septum (DDDspt). Echocardiography was performed before and within 72 h after the pacemaker implantation. The ventricular mechanical performance and asynchrony was compared in conditions of programmed rates of 60, 80 and 100/min. Results: Myocardial performance index was significantly better in DDDspt than in DDDapx patients (p = 0.003). With faster programmed rate, the QRS/RR increased (p < 0.05) in DDDapx patients with more inter- and intraventricular asynchrony, implicating the disadvantage of prolonged depolarization time. The DDDspt group demonstrated comparable parameters of diastolic function to AAI patients and preserved mechanical performance during accelerated pacing. Conclusions: RV septal pacing showed the advantages of shorter depolarization time, less ventricular contractile asynchrony, better mechanical performance and preserved chronotropic response on myocardial contractility in comparison with apical pacing.

Original languageEnglish
Pages (from-to)97-106
Number of pages10
JournalInternational Journal of Cardiology
Volume118
Issue number1
DOIs
Publication statusPublished - May 16 2007
Externally publishedYes

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Bradycardia
Heart Ventricles
Echocardiography
Heart Diseases
Therapeutics

Keywords

  • Asynchrony
  • Echocardiography
  • Electrocardiograms
  • Pacemaker
  • Septal pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Septal pacing preserving better left ventricular mechanical performance and contractile synchronism than apical pacing in patients implanted with an atrioventricular sequential dual chamber pacemaker. / Yu, Chih Chieh; Liu, Yen Bin; Lin, Mao Shin; Wang, Jen Yu; Lin, Jiunn Lee; Lin, Lung Chun.

In: International Journal of Cardiology, Vol. 118, No. 1, 16.05.2007, p. 97-106.

Research output: Contribution to journalArticle

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N2 - Background: Permanent pacing is the treatment for chronotropically incompetent hearts. However, the right ventricular (RV) apical pacing-induced asynchrony, even maintaining the atrioventricular (AV) sequential activation, has depressed left ventricular contractility. Whether RV septal pacing would less compromise the electromechanical performance of the left ventricle and the chronotropic effect on myocardial contractility, is unknown. Methods: We prospectively studied 42 patients without structural heart diseases and with symptomatic bradycardia. There were 10 patients receiving atrial pacing (AAI) pacemakers, 18 patients having AV sequential pacing at RV apex (DDDapx) and 14 patients being AV sequentially paced at septum (DDDspt). Echocardiography was performed before and within 72 h after the pacemaker implantation. The ventricular mechanical performance and asynchrony was compared in conditions of programmed rates of 60, 80 and 100/min. Results: Myocardial performance index was significantly better in DDDspt than in DDDapx patients (p = 0.003). With faster programmed rate, the QRS/RR increased (p < 0.05) in DDDapx patients with more inter- and intraventricular asynchrony, implicating the disadvantage of prolonged depolarization time. The DDDspt group demonstrated comparable parameters of diastolic function to AAI patients and preserved mechanical performance during accelerated pacing. Conclusions: RV septal pacing showed the advantages of shorter depolarization time, less ventricular contractile asynchrony, better mechanical performance and preserved chronotropic response on myocardial contractility in comparison with apical pacing.

AB - Background: Permanent pacing is the treatment for chronotropically incompetent hearts. However, the right ventricular (RV) apical pacing-induced asynchrony, even maintaining the atrioventricular (AV) sequential activation, has depressed left ventricular contractility. Whether RV septal pacing would less compromise the electromechanical performance of the left ventricle and the chronotropic effect on myocardial contractility, is unknown. Methods: We prospectively studied 42 patients without structural heart diseases and with symptomatic bradycardia. There were 10 patients receiving atrial pacing (AAI) pacemakers, 18 patients having AV sequential pacing at RV apex (DDDapx) and 14 patients being AV sequentially paced at septum (DDDspt). Echocardiography was performed before and within 72 h after the pacemaker implantation. The ventricular mechanical performance and asynchrony was compared in conditions of programmed rates of 60, 80 and 100/min. Results: Myocardial performance index was significantly better in DDDspt than in DDDapx patients (p = 0.003). With faster programmed rate, the QRS/RR increased (p < 0.05) in DDDapx patients with more inter- and intraventricular asynchrony, implicating the disadvantage of prolonged depolarization time. The DDDspt group demonstrated comparable parameters of diastolic function to AAI patients and preserved mechanical performance during accelerated pacing. Conclusions: RV septal pacing showed the advantages of shorter depolarization time, less ventricular contractile asynchrony, better mechanical performance and preserved chronotropic response on myocardial contractility in comparison with apical pacing.

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