Pastore Gianni, Aggio Silvio, Baracca Enrico, Fraccaro Chiara, Picariello Claudio, Roncon Loris, Corbucci Giorgio, Noventa Franco, Zanon Francesco
Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy
Department of Cardiology, Rovigo General Hospital, Via Tre Martiri, 140 45100 Rovigo, Italy.
Europace. 2014 Jul;16(7):1033-9. doi: 10.1093/europace/eut436. Epub 2014 Jan 27.
Right ventricular apex (RVA) pacing has adverse effects on left atrial (LA) function and may contribute to atrial arrhythmias. The effects of Hisian area (HA) pacing on LA function are still lacking. The objective of this study is to assess the left ventricular (LV) electromechanical activation/relaxation, systolic (S), diastolic (D) phases, and their effects on LA function during pacing from HA and RVA.
Thirty-seven patients with normal cardiac function underwent permanent HA pacing. In all patients, a RVA backup lead was added. The patients first underwent 3 months of HA pacing, followed by 3 months of RVA pacing. After each 3-month period, we compared by echocardiography: S-D LV electromechanical delay (S-D EMD), S-D intra-LV dyssynchrony, LV S-D phases, and their function evaluated by myocardial performance index (MPI) and mitral annular tissue Doppler early diastolic velocity (E'), pulmonary arterial systolic pressure (PASP), and LA function (LA phasic volumes and their emptying fraction). Right ventricular apex compared with HA pacing increased S-D EMD (P < 0.001) and intra-LV dyssynchrony (P < 0.001). As a consequence, a significant longer LV isovolumetric contraction time (P < 0.001) and LV isovolumetric relaxation time (P = 0.05) were measured during RVA compared with HA pacing, whereas LV ejection time was shorter (P = 0.033). Moreover, HA pacing resulted in significantly better MPI (P = 0.039), higher value of E' (P = 0.049), and lower PASP (P < 0.001). Finally, RVA compared with HA pacing was associated to higher LA volumes pre-atrial contraction (P = 0.001) and minimal volume (P = 0.003) with reduction in passive emptying fraction (P < 0.001) and total emptying fraction (P = 0.005).
Hisian area compared with RVA pacing resulted in a more physiological LV electromechanical activation/relaxation and consequently better LA function.
右心室心尖部（RVA）起搏对左心房（LA）功能有不良影响，并可能导致房性心律失常。希氏束区域（HA）起搏对LA功能的影响仍不明确。本研究的目的是评估在HA和RVA起搏期间左心室（LV）的机电激活/松弛、收缩期（S）、舒张期（D）阶段及其对LA功能的影响。
37例心功能正常的患者接受了永久性HA起搏。所有患者均植入了一根RVA备用导线。患者首先接受3个月的HA起搏，然后接受3个月的RVA起搏。在每个3个月周期结束后，我们通过超声心动图比较：S-D左心室机电延迟（S-D EMD）、S-D左心室内不同步、LV S-D阶段，以及通过心肌性能指数（MPI）和二尖瓣环组织多普勒舒张早期速度（E'）、肺动脉收缩压（PASP）和LA功能（LA阶段性容积及其排空分数）评估的功能。与HA起搏相比，RVA起搏增加了S-D EMD（P < 0.001）和左心室内不同步（P < 0.001）。因此，与HA起搏相比，RVA起搏期间测量到的左心室等容收缩时间显著延长（P < 0.001），左心室等容舒张时间延长（P = 0.05），而左心室射血时间缩短（P = 0.033）。此外，HA起搏导致MPI显著改善（P = 0.039）、E'值更高（P = 0.049）和PASP更低（P < 0.001）。最后，与HA起搏相比，RVA起搏与心房收缩前更高的LA容积（P = 0.001）和最小容积（P = 0.003）相关，被动排空分数降低（P < 0.001）和总排空分数降低（P = 0.005）。
与RVA起搏相比，HA起搏导致更生理性的左心室机电激活/松弛，从而使LA功能更好。
