Influence of non-apical permanent pacing on left ventricular systolic impairment

Adil K. Baimbetov, Aiman M. Jukenova, I Yakupova, Kenzhebek A. Bizhanov, Z H Tursunkhanov, N Bigeldiyev, N Azatkhanova

2023

Closed access Metadata (CSL-JSON)
DOI 10.1093/eurheartj/ehac779.029
Data confidence 85 high
How this score is calculated

It is built from checkable properties of the record itself: whether the article has a DOI, how many independent sources confirmed its data, whether the required fields are filled in, and how recent the latest confirmation is. Disagreement between sources and a missing identifier lower it. A value of 80 or above means the record was published without further checking; 60 to 79 means it is published at reduced confidence, with a manual check advisable. A record verified by an editor by hand is never pushed below 90 by a recalculation. This scores our data about the article, not the article itself.

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Right ventricular apical (RVA) pacing deleterious effects on left ventricular ejection fraction (LVEF) had been demonstrated. Non-apical pacing, such as right ventricular mid-septal (RVMS) and His Bundle pacing, appear as practical alternatives. Our purpose is to evaluate the effect of alternate sites of right ventricular (RV) pacing on left ventricular (LV) function and hemodynamics in patients with bradyarrhythmias. Methods We observed 118 patients (age 58±27 years, 64% men) with AV block III, who underwent permanent dual chamber pacemaker implantation. To 72 patients RV lead has implanted the middle area of RV septum (RVMS) and 46 patients’ RV lead has been implanted traditionally to the right ventricular apex (RVA). Color tissue velocity imaging was performed to analyze time to peak systolic velocity (Ts) in a 12 segment model of the LV for each pacing site. Measurements included standard deviation of time to peak systolic velocity (SD-Ts) for all segments, the maximal difference in Ts between any 2/6 basal (Ts-B), any 2/6 mid segments (Ts-M) and maximal Ts difference between any 2/12 segments (Ts-12). Stroke volume was estimated using Doppler velocity time integral (TVI) in the left ventricular outflow tract (LVOT). QRS width for each site was recorded. Measurements were observed by transthoracic echocardiography and electrocardiography before and 12 months after implantation. Results Ts-12 was significantly higher with RVA - pacing (107 ms, p=0.003) compared to RVMS - pacing (81 ms) sites. SD-Ts were significantly higher with RVA - pacing (38.5 ms, p=0.01) than RVMS - pacing (28.7 ms). QRS duration was the longest for RVA - pacing (157 ms) while significantly shorter RVMS - pacing (115 ms, p<0.001). LVOT VTI was significantly higher for RVMS - pacing than for RVA (p=0.0014) pacing. Conclusions Right ventricular mid-septal pacing may reduce electro-mechanical dyssynchrony compared to RVA pacing and RVMS – pacing to effect better LV function and hemodynamics than RVA pacing in patients with permanent pacemaker implantation.