Papadopoulou Elektra, Kaladaridou Anna, Mattheou John, Pamboucas Constantinos, Hatzidou Sophia, Antoniou Anna, Toumanidis Savvas
Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece.
Department of Clinical Therapeutics, Medical School, University of Athens, "Alexandra" Hospital, Athens, Greece.
J Am Soc Echocardiogr. 2015 Mar;28(3):347-54. doi: 10.1016/j.echo.2014.10.014. Epub 2014 Nov 26.
Right ventricular apical pacing may induce detrimental effects on left ventricular function and coronary flow. In this study, the effects of pacing site and mode on cardiac mechanics and coronary blood flow were evaluated.
This prospective study included 25 patients who received dual-chamber pacemakers with the ventricular lead placed in the right ventricular apex and presented in sinus rhythm (SR) at their regularly scheduled visits at the pacemaker clinic. Patients underwent complete transthoracic echocardiographic examinations while in SR, followed by noninvasive Doppler assessment of coronary flow in the left anterior descending coronary artery (LAD) and speckle-tracking echocardiography of short-axis planes in SR, atrial pacing (AAI-P), atrioventricular (dual-chamber) pacing (DDD-P), and ventricular pacing (VVI-P).
Rotation of the base was significantly decreased with VVI-P compared with AAI-P. Left ventricular twist decreased significantly with DDD-P compared with AAI-P. Circumferential strain of the base significantly decreased with DDD-P and VVI-P compared with SR. The velocity-time integral of diastolic flow in the LAD decreased significantly with DDD-P compared with SR (10.7 ± 2.2 vs 10.2 ± 2.2 vs 8.9 ± 1.6 vs 8.7 ± 2.6 cm in SR and with AAI-P, DDD-P, and VVI-P, respectively, P = .003). Basal rotation and time from onset of the QRS complex to peak basal rotation as a percentage of systole were independently associated with the velocity-time integral of diastolic flow in the LAD during SR and the three pacing modes.
Acute right ventricular apical pacing showed a detrimental effect on left ventricular twist and basal mechanics, with the latter being independently associated with decreased LAD diastolic flow velocity parameters.
右心室心尖部起搏可能对左心室功能和冠状动脉血流产生不利影响。在本研究中，评估了起搏部位和模式对心脏力学和冠状动脉血流的影响。
这项前瞻性研究纳入了25例接受双腔起搏器治疗的患者，其心室电极置于右心室心尖部，在起搏器门诊定期随访时呈窦性心律（SR）。患者在SR状态下接受完整的经胸超声心动图检查，随后在SR、心房起搏（AAI-P）、房室（双腔）起搏（DDD-P）和心室起搏（VVI-P）状态下对左前降支冠状动脉（LAD）进行无创多普勒冠状动脉血流评估，并对短轴平面进行斑点追踪超声心动图检查。
与AAI-P相比，VVI-P时心底旋转明显降低。与AAI-P相比，DDD-P时左心室扭转明显降低。与SR相比，DDD-P和VVI-P时心底圆周应变明显降低。与SR相比，DDD-P时LAD舒张期血流速度时间积分明显降低（SR、AAI-P、DDD-P和VVI-P时分别为10.7±2.2 vs 10.2±2.2 vs 8.9±1.6 vs 8.7±2.6 cm，P = 0.00）。SR及三种起搏模式下，心底旋转以及从QRS波群起始至心底旋转峰值的时间占收缩期的百分比与LAD舒张期血流速度时间积分独立相关。
急性右心室心尖部起搏对左心室扭转和心底力学有不利影响，后者与LAD舒张期血流速度参数降低独立相关。
