Left Ventricular Dyssynchrony Resulting from Right Ventricular Apical Pacing: Relevance of Baseline Assessment

Pastore, Gianni; Noventa, Franco; Piovesana, Piergiuseppe; Cazzin, R.; Aggio, Silvio; Verlato, Roberto; Zanon, Francesco; Baracca, Enrico; Roncon, Loris; Padeletti, Luigi; Barold, F.A.C.C. S. Serge

doi:10.1111/j.1540-8159.2008.01209.x

Cited by 47 publications

(42 citation statements)

References 23 publications

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“…Patients with very dyssynchronous LV activation during intrinsic rhythm tended to have a decrease or no change in dyssynchrony, whereas synchronously activated left ventricles were desynchronized by RVP. Our findings reproduced those of Pastore et al, 10 who also showed an inverse relation between baseline dyssynchrony and the change in dyssynchrony induced by RVP.…”

Section: Discussionsupporting

confidence: 93%

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The role of pacing-induced dyssynchrony in left ventricular remodeling associated with long-term right ventricular pacing for atrioventricular block

Pap

Gallardo

Rónaszéki

et al. 2012

Journal of Electrocardiology

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Section: Discussionsupporting

confidence: 93%

“…9,10 Furthermore, numerous reports show that dyssynchrony after long-term RVP is associated with LV dilation and reduced systolic function. 3,11 Biventricular pacing can mitigate the detrimental long-term effects of RVP, 6 further suggesting a role for LV dyssynchrony behind the deterioration of LV function.…”

Section: Discussionmentioning

confidence: 99%

The role of pacing-induced dyssynchrony in left ventricular remodeling associated with long-term right ventricular pacing for atrioventricular block

Pap

Gallardo

Rónaszéki

et al. 2012

Journal of Electrocardiology

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“…A concomitant impairment in LV systolic function was observed, reflected by a reduction in LVEF (from 56 Ϯ 8% to 48 Ϯ 9%, p ϭ 0.001) and LV longitudinal strain (from -18.3 Ϯ 3.5% to -11.8 Ϯ 3.6%, p Ͻ 0.001) (48). In 153 patients undergoing pacemaker implantation for standard indications, Pastore et al (49) assessed LV dyssynchrony using tissue Doppler echocardiography at baseline and after at least 24 h (mean 1.7 Ϯ 0.3 days) of continuous RV apical pacing. A total of 101 patients (66%) exhibited significant LV dyssynchrony.…”

Section: Discussionmentioning

confidence: 95%

“…In patients with normal LVEF, 45% of the patients developed LV dyssynchrony (40 of 89), whereas 39 of the 42 patients (93%) with moderately depressed LVEF developed LV dyssynchrony. In patients with severely depressed LVEF (n ϭ 22), all patients exhibited LV dyssynchrony during RV apical pacing(49). ANOVA ϭ analysis of variance; other abbreviations as inFigure 1.…”

mentioning

confidence: 99%

The Effects of Right Ventricular Apical Pacing on Ventricular Function and Dyssynchrony

Tops

Schalij

Bax

2009

Journal of the American College of Cardiology

339

224

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Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.

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“…Permanent pacing from the right ventricular apex (RVA) produces intraventricular dyssynchrony of cardiac contraction 1 posing a risk of left ventricular (LV) dysfunction 2 . The pathophysiological mechanism involves activation of the sympathetic adrenergic nervous and renin-angiotensin systems, impaired myocardial perfusion 3 , development of remodeling 4 with progressive worsening of LV function and cardiac failure.…”

Section: Introductionmentioning

confidence: 99%

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

Kameník¹,

Sedloň²,

Hnátek³

et al. 2013

BIOMED PAP

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Aims. To analyze the paced QRS duration in various septal positions of the right ventricular leads and with different paced QRS vectors. To use the results to assess parameters suggesting the optimal site for right ventricular pacing. Methods and Results. A total of 609 patients with leads implanted in the right ventricular septum were classified using fluoroscopy in the lateral view (the primary pacing site), and in the anteroposterior view (the secondary pacing site), according to the QRS vector in leads I and III. Significantly shortened paced QRS was found in the primary pacing site with the true septal compared with the anteroseptal site, with the vector being negative or isoelectric in lead I plus positive in lead III. In secondary pacing sites, no significant difference in pacing QRS duration was found between RVOT-HS, RVOT-LS, mid-septum and inferior-septum. Conclusions. For optimization of the pacing site in the ventricular septum, the following are significant: the primary site based on the lateral view, and the paced QRS vector in leads I and III.

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Left Ventricular Dyssynchrony Resulting from Right Ventricular Apical Pacing: Relevance of Baseline Assessment

Cited by 47 publications

References 23 publications

The role of pacing-induced dyssynchrony in left ventricular remodeling associated with long-term right ventricular pacing for atrioventricular block

The role of pacing-induced dyssynchrony in left ventricular remodeling associated with long-term right ventricular pacing for atrioventricular block

The Effects of Right Ventricular Apical Pacing on Ventricular Function and Dyssynchrony

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

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