Okada Masato, Kashiwase Kazunori, Hirata Akio, Takeda Yasuharu, Amiya Ryohei, Ueda Yasunori, Higuchi Yoshiharu, Yasumura Yoshio
Cardiovascular Division, Osaka Police Hospital.
Cardiovascular Division, Osaka National Hospital.
Int Heart J. 2018 Nov 28;59(6):1275-1287. doi: 10.1536/ihj.17-672. Epub 2018 Nov 5.
Right ventricular apical (RVA) pacing often causes left ventricular (LV) mechanical asynchrony, which is enhanced by impaired cardiac contraction and intrinsic conduction abnormality. However, data on patients with normal cardiac function and under RV non-apical (non-RVA) pacing are limited.We retrospectively investigated 97 consecutive patients with normal ejection fraction who received pacemaker implantation for atrioventricular block with the ventricular lead placed in a non-RVA position. We defined mechanical asynchrony as discoordinate contraction between opposing regions of the LV wall evaluated by echocardiography. Asynchrony was detected in 9 (9%) patients at baseline and in 38 (39%) under non-RVA pacing (P < 0.001). Asynchrony at baseline was significantly associated with complete left bundle branch block (CLBBB) [odds ratio (OR) = 20.8, P < 0.001]. Asynchrony under non-RVA pacing was significantly associated with left anterior fascicular block (LAFB) (OR = 7.14, P < 0.001) and CLBBB (OR = 13.3, P = 0.002) at baseline. New occurrence of asynchrony was significantly associated with LAFB at baseline (OR = 5.88, P = 0.001). During a median follow-up period of 4.8 years, the incidence of device-detected atrial fibrillation (AF) was more frequent in patients who developed asynchrony than in those who did not (53.3% versus 27.5%, hazard ratio = 2.17, 95% confidence interval = 1.02-4.61, P = 0.03).In patients with normal cardiac function, LAFB at baseline was significantly associated with new occurrence of mechanical asynchrony under non-RVA pacing. Abnormal contraction had a significant influence on the incidence of device-detected AF.
右心室心尖部（RVA）起搏常导致左心室（LV）机械性不同步，而心脏收缩受损和固有传导异常会加重这种情况。然而，关于心功能正常且接受右心室非心尖部（非RVA）起搏患者的数据有限。我们回顾性研究了97例连续的射血分数正常且因房室传导阻滞接受起搏器植入、心室导线置于非RVA位置的患者。我们将机械性不同步定义为通过超声心动图评估的左心室壁相对区域之间不协调收缩。基线时9例（9%）患者检测到不同步，非RVA起搏时38例（39%）检测到不同步（P<0.001）。基线时的不同步与完全性左束支传导阻滞（CLBBB）显著相关[比值比（OR）=20.8，P<0.001]。非RVA起搏时的不同步与基线时的左前分支传导阻滞（LAFB）（OR=7.14，P<0.001）和CLBBB（OR=13.3，P=0.002）显著相关。不同步的新发生与基线时的LAFB显著相关（OR=5.88，P=0.001）。在中位随访期4.8年期间，发生不同步的患者中设备检测到的心房颤动（AF）发生率高于未发生不同步的患者（53.3%对27.5%，风险比=2.17，95%置信区间=1.02 - 4.61，P=0.03）。在心功能正常的患者中，基线时的LAFB与非RVA起搏时新发生的机械性不同步显著相关。异常收缩对设备检测到的AF发生率有显著影响。
