Arakawa Yuki, Fukaya Hidehira, Kakizaki Ryota, Oikawa Jun, Saito Daiki, Sato Tetsuro, Matsuura Gen, Kobayashi Shuhei, Shirakawa Yuki, Nishinarita Ryo, Horiguchi Ai, Ishizue Naruya, Nabeta Takeru, Kishihara Jun, Niwano Shinichi, Ako Junya
Department of Cardiovascular Medicine Kitasato University School of Medicine Sagamihara Japan.
J Arrhythm. 2020 Dec 6;37(1):203-211. doi: 10.1002/joa3.12472. eCollection 2021 Feb.
Right ventricular (RV) pacing causes left ventricular (LV) dyssynchrony sometimes resulting in pacing-induced cardiomyopathy. However, RV pacing for hypertrophic obstructive cardiomyopathy is one of the treatment options. LV flow energy loss (EL) using vector flow mapping (VFM) is a novel hemodynamic index for assessing cardiac function. Our study aimed to elucidate the impact of RV pacing on EL in normal LV function and hypertrophic cardiomyopathy (HCM) patients.
A total of 36 patients with dual-chamber pacemakers for sick sinus syndrome or implantable cardioverter defibrillators for fatal ventricular tachyarrhythmias were enrolled. All patients were divided into two groups: 16 patients with HCM (HCM group) and others (non-HCM group). The absolute changes in EL under AAI (without RV pacing) and DDD (with RV pacing) modes were assessed using VFM on color Doppler echocardiography.
In the non-HCM group, the mean systolic EL significantly increased from the AAI to DDD modes (14.0 ± 7.7 to 17.0 ± 8.6 mW/m, = .003), whereas the mean diastolic EL did not change (19.0 ± 12.3 to 17.0 ± 14.8 mW/m, = .231). In the HCM group, the mean systolic EL significantly decreased from the AAI to DDD modes (26.7 ± 14.2 to 21.6 ± 11.9 mW/m, < .001), whereas the mean diastolic EL did not change (28.7 ± 16.4 to 23.9 ± 19.7 mW/m, = .130).
RV pacing increased the mean systolic EL in patients without HCM. Conversely, RV pacing decreased the mean systolic EL in patients with HCM.
右心室（RV）起搏可导致左心室（LV）不同步，有时会引发起搏诱导的心肌病。然而，RV起搏是肥厚性梗阻性心肌病的治疗选择之一。使用矢量血流图（VFM）评估左心室血流能量损失（EL）是一种评估心脏功能的新型血流动力学指标。我们的研究旨在阐明RV起搏对左心室功能正常的患者和肥厚型心肌病（HCM）患者EL的影响。
共纳入36例因病态窦房结综合征植入双腔起搏器或因致命性室性心律失常植入植入式心脏复律除颤器的患者。所有患者分为两组：16例HCM患者（HCM组）和其他患者（非HCM组）。在彩色多普勒超声心动图上使用VFM评估AAI（无RV起搏）和DDD（有RV起搏）模式下EL的绝对变化。
在非HCM组中，从AAI模式到DDD模式，平均收缩期EL显著增加（14.0±7.7至17.0±8.6 mW/m，P = 0.003），而平均舒张期EL没有变化（19.0±12.3至17.0±14.8 mW/m，P = 0.231）。在HCM组中，从AAI模式到DDD模式，平均收缩期EL显著降低（26.7±14.2至21.6±11.9 mW/m，P < 0.001），而平均舒张期EL没有变化（28.7±16.4至23.9±19.7 mW/m，P = 0.130）。
RV起搏增加了非HCM患者的平均收缩期EL。相反，RV起搏降低了HCM患者的平均收缩期EL。
