Abstract
Our study aimed at finding the incidence of overt heart failure or asymptomatic left ventricular systolic/diastolic dysfunction and cardiac dyssynchrony in patients undergoing single or dual chamber cardiac pacing and its impact on exercise capacity. 80 patients undergoing permanent pacemaker implantation (single or double chamber) were examined for various predetermined echocardiographic parameters of left ventricular systolic function, diastolic function and dyssynchrony before and one year after implantation. Also the impact of pacing on the exercise capacity is assessed by six minute walk test. The various echocardiographic parameters of left ventricular systolic function, diastolic function and dyssynchrony namely, Ejection Fraction (EF), E´ velocity, Interventricular Mechanical Delay (IVMD), Septum to Posterior Wall Motion Delay (SPWMD), Time to peak Systolic velocity between the septal and lateral wall (Ts-SL), showed no significant variation between before and after pacemaker implantation values. In patients with normal ejection fraction and with no structural heart disease there was no significant difference in the systolic, diastolic function and various dyssynchrony indices after one year of right ventricular pacing.Also right ventricular pacing did not affect the functional capacity of the patient as assessed by six minute walk test.
Keywords: Cardiac pacing, Echodoppler parameters, Left ventricular systolic function, Left ventricular diastolic function, Six minute walk test.
References
- Prinzen FW, Augustijn CH, Arts T, Allessie MA, Reneman RS. Redistribution of myocardial fiber strain and blood flow by asynchronous activation. Am J Physiol 1990; 259:H300–H308.
- Manolis AS. The deleterious consequences of right ventricular apical pacing: time to seek alternate site pacing. Pacing ClinElectrophysiol 2006;29:298–315.
- Tops LF, Schalij MJ, Holman ER, van Erven L, van der Wall EE, Bax JJ. Right ventricular pacing can induce ventricular dyssynchrony in patients with atrial fibrillation after atrioventricular node ablation. J Am CollCardiol 2006;48:1642–8.
- Bader H, Garrigue S, Lafitte S, Reuter S, Reuter S, Jaïs P, et al. Intra-left ventricular electromechanical asynchrony. A new independent predictor of severe cardiac events in heart failure patients. J Am Coll Cardiol 2004;43:248–56.
- Cho GY, Song JK, Park WJ, Han SW, Choi SH, Doo YC, et al. Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration. J Am Coll Cardiol 2005; 46:2237–2243.
- Gibson DG, Francis DP. Clinical assessment of left ventricular diastolic function. Heart 2003;89:231–8.
- Litwin SE, Gorman G, Huang SK. Effects of different pacing modes on left ventricular relaxation in closed-chest dogs. Pacing ClinElectrophysiol 1989;12: 1070 –6.
- Zile MR, Blaustein AS, Shimizu G, Gaasch WH. Right ventricular pacing reduces the rate of left ventricular relaxation and filling. J Am CollCardiol 1987;10: 702 –9.
- Bedotto JB, Grayburn PA, Black WH, Raya TE, McBride W, Hsia HH, Eichhorn EJ. Alterations in left ventricular relaxation during atrioventricular pacing in humans. J Am CollCardiol 1990;15:658 –64.
- Betocchi S, Piscione F, Villari B, Pace L, Ciarmiello A, Perrone-Filardi P, Salvatore C, Salvatore M, Chiariello M. Effects of induced asynchrony on left ventricular diastolic function in patients with coronary artery disease. J Am CollCardiol 1993;21:1124 –31.
- Fornwalt BK, Cummings RM, Arita T, Delfino JG, Fyfe DA, Campbell RM, et al. Acute pacing-induced dyssynchronous activation of the left ventricle creates systolic dyssynchrony with preserved diastolic synchrony. J Cardiovasc Electrophysiol 2008; 19:483– 8
- Mohan JC, Sethi KK, Arora R, Khalilullah M. Comparative evaluation of left ventricular function in sick sinus syndrome on different long-term pacing modes. Indian Heart J 1994; 46:303–6.
- Andersen HR, Thuesen L, Bagger JP, Vesterlund T, Thomsen PE. Prospective randomised trial of atrial versus ventricular pacing in sicksinus syndrome. Lancet 1994; 344:1523–8.
- Pehrsson SK, Aström H, Bone D. Left ventricular volumes with ventricular inhibited and atrial triggered ventricular pacing. Acta Med Scand 1983; 214:305–310.
- Faerestrand S, Ohm OJ. A time related study by Doppler and M mode echocardiography of haemodynamics, heart size and AV valvular functions during activity sensing rate responsive ventricular pacing. Pacing Clin Electrophysiol 1987; 10:507–18.
- Dwivedi SK, Bansal S, Puri A, Makharia MK, Narain VS, Saran RK, et al. Diastolic and systolic right ventricular dysfunction precedes left ventricular dysfunction in patients
- Brandon K. Fornwalt, B.S., Rose M. Cummings et al. Acute Pacing-Induced Dyssynchronous Activation of the Left Ventricle Creates Systolic Dyssynchrony with Preserved Diastolic Synchrony. J CardiovascElectrophysiol. 2008 May ; 19(5): 483–488.
- Naegeli B, Kurz DJ, Koller D, Straumann E, Furrer M, Maurer D, et al. Single chamber ventricular pacing increases markers of left ventricular dysfunction compared with dual-chamber pacing. Europace 2007; 9:194–9.
- J Kojuri, E Atabati, S Moslemi. Assessment of BNP level in patients with single chamber and dual chamber pacemakers. IntCardiovasc Res J 2010; 4:118–22.
- Theroux P, Ross J Jr, Franklin D, Kemper WS, Sasyama S. Regional myocardial function in the conscious dog during acute coronary occlusion and responses to morphine, propranolol, nitroglycerin, and lidocaine. Circulation. 1976; 53:302–14.
- Wiegner AW, Allen GJ, Bing OH. Weak and strong myocardium in series: Implications for segmental dysfunction. Am J Physiol. 1978; 235:H776–H783.
- Brutsaert DL, Housmans PR, Goethals MA. Dual control of relaxation. Its role in the ventricular function in the mammalian heart. Circ Res. 1980; 47:637–52.
- Pitzalis MV, Iacoviello M, Romito R, et al. Cardiac resynchronization therapy tailored by echocardiographic evaluation of ventricular asynchrony. J Am CollCardiol 2002;40:1615–22.
- Bax JJ, Bleeker GB, Marwick TH, et al. Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. J Am CollCardiol 2004;44:1834 – 40.
- Schmidt M, Bromsen J, Herholz C, et al. Evidence of left ventricular dyssynchrony resulting from right ventricular pacing in patients with severely depressed left ventricular ejection fraction. Europace 2007; 9: 34–40.
- Thambo JB, Bordachar P, Garrigue S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004; 110: 3766 –72.
- Tops LF, Suffoletto MS, Bleeker GB, et al. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. J Am CollCardiol 2007;50:1180–8.
Corresponding Author
Lipika Adhikari
Assistant Professor, Cardiology Department, RG Kar Medical College, Kolkata
Address: C/O Manoj Adhikari, School Danga, post & district Bankura, West Bengal, PIN 722101, India
DOI: https://dx.doi.org/10.18535/jmscr/v6i9.125
