Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China.
Europace. 2011 Apr;13(4):514-9. doi: 10.1093/europace/euq521. Epub 2011 Feb 4.
Right ventricular apical (RVA) pacing can induce left ventricular (LV) dyssynchrony and dysfunction. In this article, we describe the prevalence, clinical characteristics, and outcome in a subset of patients with unrecognized LV apical akinetic aneurysmatic area associated with permanent RVA pacing as potential causes of heart failure (HF) and/or ventricular tachyarrhythmias (VT).
We retrospectively studied 220 patients with permanent RVA pacing and no pre-existing structural heart disease in our follow-up clinic for high-degree atrioventricular block. Patients who presented with new-onset HF, chest pain, or VT following RVA pacing were evaluated by echocardiogram and cardiac catheterization. RVA pacing-induced LV apical akinetic aneurysmatic area was diagnosed in the absence of significant coronary artery disease by left ventriculogram. After a mean 8.8 ± 6.3 years, eight patients (3.6%) had LV apical akinetic aneurysmatic area. Of those with LV apical akinetic aneurysmatic area, four patients presented with or died of VT. There was no evidence of LV apical akinetic aneurysmatic area on echocardiogram or left ventriculogram in the remaining 212 patients. The four patients with LV apical akinetic aneurysmatic area and HF underwent cardiac resynchronization therapy: in all cases LV ejection fraction improved (from 33 ± 6 to 47 ± 10%, P = 0.03), and LV apical akinetic aneurysmatic area resolved in two.
Permanent RVA pacing for high-degree atrioventricular block is associated with LV apical akinetic aneurysmatic area. This condition was associated with a high incidence of VT and cardiovascular complication, but was possibly reversible with cardiac resynchronization therapy.
右心室心尖（RVA）起搏可导致左心室（LV）不同步和功能障碍。本文描述了一组与永久性 RVA 起搏相关的、未被识别的 LV 心尖运动障碍性动脉瘤样区域的患者的患病率、临床特征和结局，这些患者可能是心力衰竭（HF）和/或室性心动过速（VT）的潜在原因。
我们回顾性研究了 220 例在我们的高级房室传导阻滞随访诊所中接受永久性 RVA 起搏且无先前结构性心脏病的患者。在 RVA 起搏后出现新发 HF、胸痛或 VT 的患者，通过超声心动图和心导管检查进行评估。通过左心室造影在无明显冠状动脉疾病的情况下诊断 RVA 起搏诱导的 LV 心尖运动障碍性动脉瘤样区域。在平均 8.8 ± 6.3 年后，8 例（3.6%）患者出现 LV 心尖运动障碍性动脉瘤样区域。在有 LV 心尖运动障碍性动脉瘤样区域的患者中，有 4 例出现或死于 VT。在其余 212 例患者中，超声心动图或左心室造影均未见 LV 心尖运动障碍性动脉瘤样区域。有 LV 心尖运动障碍性动脉瘤样区域和 HF 的 4 例患者接受了心脏再同步治疗：所有患者的 LV 射血分数均改善（从 33 ± 6%提高至 47 ± 10%，P = 0.03），其中 2 例患者的 LV 心尖运动障碍性动脉瘤样区域得到解决。
高度房室传导阻滞的永久性 RVA 起搏与 LV 心尖运动障碍性动脉瘤样区域相关。这种情况与 VT 和心血管并发症的发生率较高相关，但可能通过心脏再同步治疗逆转。
