Atrial enlargement in symptomatic heart block patients with preserved left ventricular function: Possibly related to atrioventricular dyssynchrony

Lin, Yu‐Sheng; Guo, G. Bih-Fang; Chen, Yung‐Lung; Tsai, Tzu‐Hsien; Pan, Kuo‐Li; Liu, Wenhao; Chen, Mien‐Cheng

doi:10.1016/j.ijcard.2009.11.005

Cited by 16 publications

(18 citation statements)

References 17 publications

(20 reference statements)

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“…During the same period, there has been an increased use of implantable devices for standard cardiac pacing or defibrillation, which in turn can promote or worsen both AFib and HF because of the possible deleterious effects of right ventricular (RV) pacing 1,2 . Recent evidence suggests that ventricular dyssynchrony due to RV apical pacing mimicking a left bundle branch block (LBBB) 3 may have adverse effects on left ventricular (LV) and left atrial structure and function 4 . These adverse effects probably explain the association of RV pacing, independent from atrioventricular (AV) synchrony, with increased risks of AFib and HF in randomized clinical trials of pacemaker (PM) therapy 5, 6 and, additionally, HF and death during implantable cardioverter‐defibrillator (ICD) therapy 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Adverse Effects of Long‐Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure

Sisti

Márquez

Tonet

et al. 2012

Pacing Clinical Electrophis

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In patients needing a pacemaker (PM) for bradycardia indications, the amount of right ventricular (RV) apical pacing has been correlated with atrial fibrillation (AFib) and heart failure (HF) in both DDD and VVI mode. RV pacing was linked with left ventricular (LV) dyssynchrony in almost 50% of patients with PM implantation and atrioventricular (AV) node ablation for AFib. In patients with normal systolic function needing a PM, apical RV pacing resulted in LV ejection fraction (LVEF) reduction. These negative effects were prevented by cardiac resynchronization therapy (CRT). Algorithms favoring physiological AV conduction are possible useful tools able to maintain both atrial and ventricular support and limit RV pacing. However, when chronic RV pacing cannot be avoided, it appears necessary to reconsider the cut-off value of basic LVEF for CRT. In HF patients, RV pacing can induce greater LV dyssynchrony, enhanced by underlying conduction diseases. In this context, a more deleterious effect of RV pacing in implantable cardioverter-defibrillator (ICD) patients with low LVEF can be expected. In some major ICD trials, DDD mode was correlated with increased mortality/HF. This negative impact was attributed to unnecessary RV pacing >40-50%, virtually absent in VVI-40 mode. However, some data suggest that avoiding RV pacing may also not be the best option for patients requiring an ICD. In patients with impaired LV function, AV synchrony should therefore be ensured. The best pacing mode in ICD patients with HF should be defined on an individual basis.

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Section: Introductionmentioning

confidence: 99%

Adverse Effects of Long‐Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure

Sisti

Márquez

Tonet

et al. 2012

Pacing Clinical Electrophis

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“…However, in this study, pacing percentage and pacing QRS length was not associated with the development of progressive post-implant TR. Our previous study showed that right and left atrial sizes were larger in patients with atrioventricular dyssynchrony after pacing 14 . Atrial enlargement is a wellknown predictor of atrial brillation.…”

Section: Discussionmentioning

confidence: 90%

Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient after Transvenous Permanent Pacemaker Implantation

Lee

Fang

Chen

et al. 2020

Preprint

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Background The association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation. Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant. Results 198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG, whereas 877 patients (group 2) did not have progressive post-implant TR. Group 1 had larger change in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) was an independent predictor of progressive post-implant TR. Conclusions After a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG was an independent predictor of progressive post-implant TR.

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“…Atrial enlargement is a well known predictor of atrial brillation. Utsunomiya et al reported that functional TR with a structurally normal tricuspid valve may occur secondary to chronic atrial brillation and is associated with advanced age and right atrial enlargement 15 .…”

Section: Discussionmentioning

confidence: 99%

Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient After Transvenous Permanent Pacemaker Implantation

Lee

Fang

Chen

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

BackgroundThe association of post-implant tricuspid regurgitation (TR) and heart failure (HF) hospitalization in patients without HF and preexisting abnormal TR and TR pressure gradient (PG) remain unclear. This study aimed to explore the clinical outcomes about progressive post-implant TR after permanent pacemaker (PPM) implantation.Methods A total of 1,670 patients who underwent a single ventricular or dual-chamber transvenous PPM implantation at our hospital between January 2003 and December 2017 were included in the study. Patients with prior valvular surgery, heart failure (HF), and baseline abnormal TR and TRPG were excluded. Finally, a total of 1,075 patients were enrolled in this study. Progressive TR was defined as increased TR grade of ≥2 degrees and/or TRPG of >30 mmHg after implant.Results198 (18.4%) patients (group 1) experienced progressive post-implant TR and/or elevated TRPG. Group 1 had l larger changes in post-implant TRPG (group 1 vs. group 2; 12.8 ± 9.6 mmHg vs. 1.1 ± 7.6 mmHg; p < 0.001) than group 2 without progressive post-implant TR. Group 1 had a higher incidence of HF hospitalization compared to group 2 (13.6% vs. 4.7%; p < 0.001). Pre-implant TRPG (HR: 1.075; 95% confidence interval (CI): 1.032-1.121; p = 0.001) and post-implant left atrial dimension (HR: 1.076; 95% CI: 1.038-1.114; p < 0.001) were independent predictors of progressive post-implant TR. ConclusionsAfter a transvenous ventricular-based PPM implantation, 18.4% of patients experienced progressive post-implant TR and/or elevated TRPG. Higher pre-implant TRPG and larger post-implant LA dimension were independent predictors of progressive post-implant TR.

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Atrial enlargement in symptomatic heart block patients with preserved left ventricular function: Possibly related to atrioventricular dyssynchrony

Cited by 16 publications

References 17 publications

Adverse Effects of Long‐Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure

Adverse Effects of Long‐Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure

Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient after Transvenous Permanent Pacemaker Implantation

Progressive Tricuspid Regurgitation and Elevated Tricuspid Regurgitation Pressure Gradient After Transvenous Permanent Pacemaker Implantation

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