Is Conventional Cardiac Pacing Harmful in Patients with Normal Ventricular Function?

Abstract

BackgroundRight ventricular pacing may be deleterious in patients with left ventricular dysfunction, but in patients with normal function the impact of this stimulation triggering clinically relevant ventricular dysfunction is not fully established.ObjectivesTo evaluate the clinical, echocardiographic findings of patients with previously normal left ventricular function underwent implantation of a pacemaker.MethodsObservational, cross-sectional study with 20 patients, who underwent implantation of pacemaker, prospectively followed-up, with the following inclusion criteria: normal left ventricular function defined by echocardiography and ventricular pacing higher than 90%. Were evaluated functional class (FC) (New York Heart Association), 6-minute walk test (6MWT), B-type natriuretic peptide (BNP), echocardiographic assessment (conventional and dyssynchrony parameters), and quality of life questionnaire (QLQ) (SF-36). The assessment was performed at ten days (t1), four months (t2), eight months (t3), 12 months (t4) and 24 months (t5).ResultsConventional echocardiographic parameters and dyssynchrony parameters showed statistically significant variation over time. The 6MWT, FC, and BNP showed worsening at the end of two years. QLQ showed initial improvement and worsening at the end of two years.ConclusionThe implantation of conventional pacemaker was associated with worsening in functional class, worsening in walk test, increased BNP levels, increased duration of QRS, and worsening in some domains of the QLQ at the end of two years. There were no changes in echocardiography measurements (conventional and asynchrony measures).

Dessincronia ventricular e aumento dos níveis de BNP na estimulação apical do ventrículo direito

“…The LV pre-ejection time, for instance, assessed in the present study, is useful to quantify intraventricular dyssynchrony with good reproducibility according to previous studies, such as the CARE-HF study 21 . Recently, Sá et al 22 observed the prolonging of this measurement in a small group of patients, who were also Chagasic with normal LVEF, throughout an eight-month period. The authors observed that although the LVPET measurements did not reach the cutoff required for the diagnosis of VD (≥ 140 ms), this was the only assessed VD measure that showed increases throughout follow-up.…”

Quality of life of patients with implanted devices for permanent cardiac pacing assessed with the SF-36v2 Health Survey

“…W dotychczasowych doniesieniach na ten temat można spotkać rozbieżności w odniesieniu do różnych urządzeń. Niektóre badania potwierdzają poprawę stanu psychicznego chorych po implantacji PM [10,14], natomiast inne przedstawiają odmienne wyniki [15]. Rozbieżności występują również w ocenie chorych po implantacji ICD i CRT.…”

Physiological cardiac pacing: Current status

“…The MOST study showed that the patients with baseline lower ejection fraction (EF), history of myocardial infarction, and a worse New York Heart Association (NYHA) functional class are more likely to have these adverse events 2 . Batista and his colleagues have shown that even in patients with normal baseline ventricular function, conventional RV apical pacing leads to change in functional class, worsening in walk test, increased B type natriuretic peptide levels at the end of 2 years 5 . Over time, the sequelae of chronic pacing from the RV apex are a higher risk of development of left ventricular dysfunction, heart failure, AF, and death 6, 7, 8, 9.…”