Echocardiographic evaluation of septal motion in patients with artificial pacemakers: Vectorcardiographic correlations

Zoneraich, Samuel; Zoneraich, Olga; Rhee, Jai J.

doi:10.1016/s0002-8703(77)80010-0

Cited by 36 publications

(8 citation statements)

References 10 publications

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“…Abnormal septal motion of type A and B was similar to that of complete atrioventricular block during right ventricular pacing. Moreover, experimental study disclosed that ventricular activation begins on the right side of the septum and invades this structure from right to left before activating the free wall of the left ventricle in complete left bundle-branch block (Becker et al, 1958;Sodi-Pallares, 1963;Scott, 1965 (Gomes et al, 1977;Zoneraich et al, 1977). However, it is also possible that the septal myocardium is damaged to some degree (though not so extensively as in type C) in type A, in contrast to type B.…”

Section: Discussionmentioning

confidence: 99%

M-mode and cross-sectional echocardiographic study of the left ventricular wall motions in complete left bundle-branch block.

Fujii¹,

Wantanabe²,

Watanabe³

et al. 1979

Heart

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SUMMARY M-mode and cross-sectional echocardiograms of 37 patients with complete left bundle-branch block were compared with those of 5 patients with complete atrioventricular block during right ventricular pacing, 20 patients with anteroseptal infarction, and 20 normal subjects.Of 37 patients with complete left bundle-branch block, 35 showed 3 types (A, B, and C) of abnormal septal motion and 2 patients showed normal septal motion. In type A and B, early and abrupt posteriorlydirected motion of the septum occurred during the pre-ejection period. After this early abnormal motion, the septum moved anteriorly in type A and posteriorly in type B. Type C exhibited akinetic or dyskinetic septal motion throughout systole. The onset of posterior wall contraction was delayed in all patients with complete left bundle-branch block.These patterns of abnormal septal motion were observed in almost all portions of upper-to mid-septum that could be recorded by cross-sectional echocardiography.Abnormal septal motion of types A and B was also observed during right ventricular pacing. It is suggested that abnormal septal motion of types A and B could be explained by asynchronous contraction of the left ventricle, with delayed activation of the left side of the septum and of the left ventricular free wall.The septal motion of type C is almost the same as that seen in patients with extensive septal infarction. Most of the patients having abnormal septal motion of type C had electrocardiographic and vectorcardiographic findings which were compatible with extensive septal infarction. Thus patients with complete left bundle-branch block and type C motion may have sufficient septal damage to prevent the early posterior motion seen in type A and B patients. Different sequence of ventricular activation will be responsible for the difference between type A and B. It is also possible that some patients with type A septal motion may have septal damage to some degree, in contrast to type B.Normal septal motion recorded in 2 patients with complete left bundle-branch block might be the result of a peripheral block of the left bundle-branch.M-mode and cross-sectional echocardiography have proved to be valuable in the study of left ventricular wall motion and the assessment of left ventricular function (Diamond et al., 1971;Jacobs et al., 1973, Fujii et al., 1976.Recently, echocardiography has disclosed a characteristic ventricular septal motion in patients with left bundle-branch block (McDonald, 1973;Dillon et al., 1974). It has been suggested that abnormal septal motion is related to an altered Received for publication 3 April 1979 sequence of activation and contraction. However, no studies have been performed to analyse the left ventricular wall motion in left bundle-branch block by cross-sectional echocardiography.The purpose of this study was (1) to analyse the motion of the interventricular septum and the left ventricular posterior wall in patients with complete left bundle-branch block by M-mode and crosssectional echocardiography; (2)...

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Section: Discussionmentioning

confidence: 99%

M-mode and cross-sectional echocardiographic study of the left ventricular wall motions in complete left bundle-branch block.

Fujii¹,

Wantanabe²,

Watanabe³

et al. 1979

Heart

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“…We excluded patients who had additional possible etiology for ASM, such as preexisting regional wall motion abnormality, left ventricular (LV) dysfunction, hypertrophic cardiomyopathy,6) previous pericardiectomy,7) postoperative severe tricuspid regurgitation,8) and conduction system-based abnormalities (permanent implanted pacemaker,9) left bundle branch block,10) or ventricular pre-excitation11)). The selection yielded a study group of 165 patients [60 ± 13 years, 92 men (56%)].…”

Section: Methodsmentioning

confidence: 99%

Echocardiographic Investigation of the Mechanism Underlying Abnormal Interventricular Septal Motion after Open Heart Surgery

Kang

Chang

Cho

et al. 2014

J Cardiovasc Ultrasound

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BackgroundAbnormal interventricular septal motion (ASM) is frequently observed after open heart surgery (OHS). The aim of this study was to investigate the incidence and temporal change of ASM, and its underlying mechanism in patients who underwent OHS using transthoracic echocardiography (TTE).MethodsIn total, 165 patients [60 ± 13 years, 92 (56%) men] who underwent coronary bypass surgery or heart valve surgery were consecutively enrolled in a prospective manner. TTE was performed preoperatively, at 3--6-month postoperatively, and at the 1-year follow-up visit. Routine TTE images and strain analysis were performed using velocity vector imaging.ResultsASM was documented in 121 of 165 patients (73%) immediately after surgery: 26 patients (17%) presented concomitant expiratory diastolic flow reversal of the hepatic vein, 11 (7%) had inferior vena cava plethora, and 11 (7%) had both. Only 2 patients (1%) showed clinically discernible constriction. ASM persisted 3--6 months after surgery in 38 patients (25%), but only in 23 (15%) after 1 year. There was no difference in preoperative and postoperative peak systolic strain of all segments of the left ventricle (LV) between groups with or without ASM. However, systolic radial velocity (VRad) of the mid anterior-septum and anterior wall of the LV significantly decreased in patients with ASM.ConclusionAlthough ASM was common (74%) immediately after OHS, it disappeared over time without causing clinically detectable constriction. Furthermore, we consider that ASM might not be caused by myocardial ischemia, but by the decreased systolic VRad of the interventricular septum after pericardium incision.

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“…5 Electrical depolarization of the heart by a pacing catheter positioned in the right ventricular apex may produce a characteristically prominent brief, posterior -C motion of the ventricular septum followed by normal septal motion with an exaggerated septal notch during isovolumic relaxation.6 Absence of the early posterior ventricular septal movement has been reported with improper pacemaker positioning. 6 Patients with left bundle branch block without pacemakers may also show a similar posterior septal deflection, but it is followed by abnormal anterior septal motion during the remainder of systole.7`This initial ventricular septal motion abnormality has been attributed to early activation and contraction of the ventricular septum by the artificial pacemaker. 6 Vectorcardiography has shown septal activation to be different in natural left bundle branch block when compared with left bundle branch block induced by an artificial pacemaker.…”

Section: Two-dimensional Studiesmentioning

confidence: 99%

“…6 Patients with left bundle branch block without pacemakers may also show a similar posterior septal deflection, but it is followed by abnormal anterior septal motion during the remainder of systole.7`This initial ventricular septal motion abnormality has been attributed to early activation and contraction of the ventricular septum by the artificial pacemaker. 6 Vectorcardiography has shown septal activation to be different in natural left bundle branch block when compared with left bundle branch block induced by an artificial pacemaker. The septal activation induced by the artificial pacer (with its initial superior and posterior orientation of the QRS loop) prevents the delay in left ventricular free wall activation which occurs in natural left bundle branch block and results in the paradoxical motion of the ventricular septum.6 A prominent early ventricular septal motion of this type, together with an exaggerated septal notch during isovolumic relaxation, has also been reported in individuals with type B'0 or group 1 Wolff-Parkinson-White Syndrome'1 (preexcitation of the anterior right ventricle).…”

Section: Two-dimensional Studiesmentioning

confidence: 99%

Echocardiographic evaluation of intracardiac pacing catheters: M-mode and two-dimensional studies.

Reeves¹,

Nanda²,

Barold³

1978

Circulation

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SUMMARY Thirty patients with right ventricular (RV) and 15 with coronary sinus (CS) pacing catheters were studied by M-mode echocardiography. RV catheters, detected in 23, appeared as linear echoes in the right ventricle during mitral valve recordings in 12, adjacent or superimposed on the tricuspid valve (TV) in 14, and immediately anterior to aortic root and pulmonary valve echoes in two with a redundant loop in RV outflow. In three with complete heart block, prominent systolic anterior movements of the TV occurred when atrial systole coincided with ventricular systole, probably due to catheter-induced TV "buckling" or exaggerated TV annular motion. Catheter echoes mimicked TV recordings in three, since its motion pattern was similar, although delayed and mimicked prolapsing right atrial myxomas in two because of multilayered com Seven of the patients (six adults, one child) with right ventricular and five with coronary sinus pacing catheters were examined by two-dimensional echocardiography using a commercially available Picker mechanical sector scanner. The transducer was placed in the left parasternal region and the long axis of the left and right ventricles were scanned. Next, the transducer was placed in the region of the left ventricular apex, and directed medially where a four chambered view (right atrium, right ventricle, left atrium, left ventricle) of the heart was obtained with visualization of the right ventricular apex. ResultsIntracardiac catheters were identified as thick linear complexes of intense echoes within right heart cavities. Frequent reverberations were recorded next to the main catheter echo ( fig. 1)

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Echocardiographic evaluation of septal motion in patients with artificial pacemakers: Vectorcardiographic correlations

Cited by 36 publications

References 10 publications

M-mode and cross-sectional echocardiographic study of the left ventricular wall motions in complete left bundle-branch block.

M-mode and cross-sectional echocardiographic study of the left ventricular wall motions in complete left bundle-branch block.

Echocardiographic Investigation of the Mechanism Underlying Abnormal Interventricular Septal Motion after Open Heart Surgery

Echocardiographic evaluation of intracardiac pacing catheters: M-mode and two-dimensional studies.

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