Intramural dyssynchrony from acute right ventricular apical pacing in human subjects with normal left ventricular function

Alan J. Bank; David S. Schwartzman; Kevin V. Burns; Christopher L. Kaufman; Stuart W. Adler; Aaron S. Kelly; Lauren Johnson; Daniel R. Kaiser

doi:10.1007/s12265-010-9176-8

Intramural dyssynchrony from acute right ventricular apical pacing in human subjects with normal left ventricular function

Alan J. Bank, David S. Schwartzman, Kevin V. Burns, Christopher L. Kaufman, Stuart W. Adler, Aaron S. Kelly, Lauren Johnson, Daniel R. Kaiser

Research output: Contribution to journal › Article › peer-review

15 Scopus citations

Abstract

Ventricular pacing causes early myocardial shortening at the pacing site and pre-stretch at the opposing ventricular wall. This contraction pattern is energetically inefficient and may lead to decreased cardiac function. This study was designed to describe the acute effects of right ventricular apical (RV _a) pacing on dyssynchrony and systolic function in human subjects with normal left ventricular (LV) function and compare these effects to pacing from alternate ventricular sites. Patients (n∈=∈26) undergoing an electrophysiology evaluation were studied during atrial pacing (AAI) and dual chamber pacing from the RV_a, left ventricular free wall (LV _fw), and the combination of RV_a and LV_fw (BiV). Tissue Doppler imaging was used to measure intramural dyssynchrony by utilizing an integrated cross-correlation synchrony index (CCSI) from the apical 4-chamber view. RV_a and BiV pacing significantly reduced systolic function as measured by longitudinal systolic contraction amplitude (SCA _long) (p∈<∈0.05) and LV velocity time integral (VTI) (p∈<∈0.05) compared to AAI and LV_fw pacing. RV _a (and to a lesser extent BiV) pacing resulted in septal and lateral intramural dyssynchrony as indicated by significantly (p∈<∈0.05) lower CCSI values as compared to AAI. CCSI was significantly (p∈<∈0.05) worse during RV_a than LV_fw pacing. In patients with normal LV function, acute ventricular pacing in the RV _a alone, or in conjunction with LV_fw pacing (BiV), results in impaired regional and global LV systolic function and intramural dyssynchrony as compared to LV_fw pacing alone.

Original language	English (US)
Pages (from-to)	321-329
Number of pages	9
Journal	Journal of cardiovascular translational research
Volume	3
Issue number	4
DOIs	https://doi.org/10.1007/s12265-010-9176-8
State	Published - Aug 2010
Externally published	Yes

Bibliographical note

Funding Information:
Disclosures Dr. Bank receives honoraria and research grant support from Medtronic and Boston Scientific. Dr. Schwartzman is a consultant and receives research grant support from Medtronic and receives grant support from St. Jude Medical. Mr. Burns and Dr. Johnson have no disclosures. Dr. Kaufman received honoraria and research grant support from Medtronic and Boston Scientific. Dr. Adler receives honoraria and research grant support from Medtronic, Boston Scientific and St. Jude Medical. Dr. Kelly received research grant support from Medtronic and Boston Scientific. Dr. Kaiser was formerly an employee of Medtronic.

Funding Information:
study was funded by Medtronic, Inc.,

Keywords

Echocardiography
Hemodynamics
Mechanics
Pacing
Tissue Doppler Imaging

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abstract = "Ventricular pacing causes early myocardial shortening at the pacing site and pre-stretch at the opposing ventricular wall. This contraction pattern is energetically inefficient and may lead to decreased cardiac function. This study was designed to describe the acute effects of right ventricular apical (RV a) pacing on dyssynchrony and systolic function in human subjects with normal left ventricular (LV) function and compare these effects to pacing from alternate ventricular sites. Patients (n∈=∈26) undergoing an electrophysiology evaluation were studied during atrial pacing (AAI) and dual chamber pacing from the RVa, left ventricular free wall (LV fw), and the combination of RVa and LVfw (BiV). Tissue Doppler imaging was used to measure intramural dyssynchrony by utilizing an integrated cross-correlation synchrony index (CCSI) from the apical 4-chamber view. RVa and BiV pacing significantly reduced systolic function as measured by longitudinal systolic contraction amplitude (SCA long) (p∈<∈0.05) and LV velocity time integral (VTI) (p∈<∈0.05) compared to AAI and LVfw pacing. RV a (and to a lesser extent BiV) pacing resulted in septal and lateral intramural dyssynchrony as indicated by significantly (p∈<∈0.05) lower CCSI values as compared to AAI. CCSI was significantly (p∈<∈0.05) worse during RVa than LVfw pacing. In patients with normal LV function, acute ventricular pacing in the RV a alone, or in conjunction with LVfw pacing (BiV), results in impaired regional and global LV systolic function and intramural dyssynchrony as compared to LVfw pacing alone.",

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note = "Funding Information: Disclosures Dr. Bank receives honoraria and research grant support from Medtronic and Boston Scientific. Dr. Schwartzman is a consultant and receives research grant support from Medtronic and receives grant support from St. Jude Medical. Mr. Burns and Dr. Johnson have no disclosures. Dr. Kaufman received honoraria and research grant support from Medtronic and Boston Scientific. Dr. Adler receives honoraria and research grant support from Medtronic, Boston Scientific and St. Jude Medical. Dr. Kelly received research grant support from Medtronic and Boston Scientific. Dr. Kaiser was formerly an employee of Medtronic. Funding Information: study was funded by Medtronic, Inc.,",

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N2 - Ventricular pacing causes early myocardial shortening at the pacing site and pre-stretch at the opposing ventricular wall. This contraction pattern is energetically inefficient and may lead to decreased cardiac function. This study was designed to describe the acute effects of right ventricular apical (RV a) pacing on dyssynchrony and systolic function in human subjects with normal left ventricular (LV) function and compare these effects to pacing from alternate ventricular sites. Patients (n∈=∈26) undergoing an electrophysiology evaluation were studied during atrial pacing (AAI) and dual chamber pacing from the RVa, left ventricular free wall (LV fw), and the combination of RVa and LVfw (BiV). Tissue Doppler imaging was used to measure intramural dyssynchrony by utilizing an integrated cross-correlation synchrony index (CCSI) from the apical 4-chamber view. RVa and BiV pacing significantly reduced systolic function as measured by longitudinal systolic contraction amplitude (SCA long) (p∈<∈0.05) and LV velocity time integral (VTI) (p∈<∈0.05) compared to AAI and LVfw pacing. RV a (and to a lesser extent BiV) pacing resulted in septal and lateral intramural dyssynchrony as indicated by significantly (p∈<∈0.05) lower CCSI values as compared to AAI. CCSI was significantly (p∈<∈0.05) worse during RVa than LVfw pacing. In patients with normal LV function, acute ventricular pacing in the RV a alone, or in conjunction with LVfw pacing (BiV), results in impaired regional and global LV systolic function and intramural dyssynchrony as compared to LVfw pacing alone.

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Intramural dyssynchrony from acute right ventricular apical pacing in human subjects with normal left ventricular function

Abstract

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Keywords

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