Atrial Pacing Affects Left Atrial Morphological and Functional Parameters Early after Pacemaker Implantation

Abstract

Background and Objectives: Chronic atrial stimulation might impair left atrial (LA) function. We aimed to assess the impact of atrial pacing burden on LA volumetric and functional parameters after implantation of a dual-chamber pacemaker. Materials and Methods: The prospective study included 121 subjects with sinus node disease (SND) or atrioventricular block (AVB) that received a dual-chamber pacemaker. After device implantation, the subjects were divided into three groups: (1) SND with a lower rate (LR) set to 60 bpm and rate response enabled; (2) AVB with an LR set to 60 bpm and no rate response; and (3) AVB with an LR set to 40 bpm and no rate response. Subjects were followed at one and three months. Two subsets of patients with high and low atrial pacing burdens accompanied by low ventricular pacing percentage were analyzed. LA function was evaluated with volumetric and strain parameters from transthoracic echocardiography. Results: The high atrial low ventricular pacing group consisted of 38 subjects, and the low atrial low ventricular group consisted of 22 subjects. When looking at the change in volumetric parameters, we observed a tendency for volumes to increase in both groups; however, only minimal LA volume reached statistical significance at three months in the high atrial pacing group. A trend towards the lowering of an active emptying fraction at one month (p = 0.076) became significant at three months (p = 0.043), and was also only observed in the same group. Moreover, a decrease in the tendency to reach statistical significance at three months for reservoir and contractile strain parameters and stiffness index was only observed in the high atrial pacing group. Meanwhile, in the low atrial pacing burden group, all parameters remained significantly unchanged. Conclusions: The burden of right atrial pacing in patients with preserved left ventricular function negatively influences functional and morphologic LA parameters. Moreover, negative effects take place soon after pacemaker implantation and appear to be sustained.

Atrial Pacing Negatively Affects Left Atrial Morphological and Functional Parameters Similarly to Atrioventricular Dyssynchrony

“…They noticed a link between higher atrial pacing burden and reduced LA reverse remodeling [ 13 ]. We have previously demonstrated that more atrial pacing was linked to negative LA remodeling and worsened systolic and diastolic LA functions in patients with preserved LV EF receiving dual-chamber pacemakers [ 15 ]. Though the degree to which different pacing modes, interatrial and AV dyssynchrony, RA pacing burden affected LA function remained unclear.…”

“…Atrial pacing by itself can also cause deterioration of LA function. That can result in arrhythmias regardless of reduced or preserved LV systolic function [ 10 , 11 , 12 , 13 , 14 , 15 ]. In a population of patients with reduced LV ejection fraction (LVEF) receiving cardiac resynchronization therapy, higher right atrial (RA) pacing burden can lead to worsening of LA function, higher risk of AF and HF worsening [ 13 ].…”