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European Journal of Echocardiography Advance Access published online on March 29, 2008
European Journal of Echocardiography, doi:10.1093/ejechocard/jen108
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Right ventricular outflow and apical pacing comparably worsen the echocardioghraphic normal left ventricle{dagger}

Tim J.F. ten Cate1,2,*, Mike G. Scheffer3, George R. Sutherland4, J. Fred Verzijlbergen2 and Norbert M. van Hemel1

1 Department of Cardiology, Sint Antonius Hospital, Koekoekslaan 1, Nieuwegein 3435 CM, The Netherlands
2 Department of Nuclear Medicine, Sint Antonius Hospital, Nieuwegein, The Netherlands
3 Department of Cardiology, MCRZ Clara location, Rotterdam, The Netherlands
4 Department of Cardiology, St Georges Hospital, London, UK

Received 23 September 2007; .

* Corresponding author. Tel: +31 30 6092432; fax: +31 30 6092325. E-mail address: timtencate{at}yahoo.com


  Abstract

Aims: A depressed left ventricular function (LVF) is sometimes observed during right ventricular apical (RVA) pacing, but any prediction of this adverse effect cannot be done. Right ventricular outflow tract (RVOT) pacing is thought to deteriorate LVF less frequently because of a more normal LV activation pattern. This study aims to assess the acute effects of RVA and RVOT pacing on LVF in order to determine the contribution of echocardiography for the selection of the optimum pacing site during pacemaker (PM) implantation.

Methods and results: Fourteen patients with a DDD-pacemaker (7 RVA, 7 RVOT) and normal LVF without other cardiac abnormalities were studied. PM dependency, because of sick sinus syndrome with normal atrioventricular and intraventricular conduction, was absent in all, allowing acute programming changes. Wall motion score (WMS), longitudinal LV strain, and tissue Doppler imaging for electromechanical delay were assessed with echocardiography during AAI pacing constituting baseline and DDD pacing. The WMS was normal at baseline (AAI pacing) in all patients and LV dyssynchrony was absent. Acute RVA and RVOT pacing deteriorated WMS, electromechanical delay, and longitudinal LV strain, but no difference of the deterioration between both pacing sites was present and dyssynchrony did not emerge.

Conclusion: Both acute RVA and RVOT pacing negatively affect WMS, longitudinal LV strain, and mechanical activation times, without clear differences between both pacing sites. Thus echocardiographic techniques do not facilitate the selection between RVOT and RVA pacing to exclude adverse effects on LVF during PM implantation in patients with a normal LVF.

Keywords: Echocardiography; Right ventricular pacing; Left ventricular function

{dagger} All authors have participated in the study design, analysis of data and in drafting and revising and final approval of the manuscript before submission.


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L. F. Tops, M. J. Schalij, and J. J. Bax
The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy.
J. Am. Coll. Cardiol., August 25, 2009; 54(9): 764 - 776.
[Abstract] [Full Text] [PDF]


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