Technische Universität Dresden, (Campus Chemnitz), Klinikum Chemnitz, Flemmingstrasse 2, 09116, Chemnitz, Germany.
Technische Universität Dresden, University of Dresden, Fetscherstrasse 76, 01307, Dresden, Germany.
BMC Cardiovasc Disord. 2022 Jan 31;22(1):23. doi: 10.1186/s12872-021-02429-0.
The incidence of worsened clinical outcome due to high right ventricular (RV) pacing burden in patients with preserved left ventricular function remains controversial.
To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameters.
In 60 pacemaker patients with preserved left ventricular ejection fraction (LVEF) serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally, in 48 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation.
The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP < 40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12-month pacemaker therapy no changes to left ventricular end diastolic diameter (LVEDD), left ventricular end systolic diameter (LVESD), LVEF, E/A-ratio; E/E'-ratio and tricuspid annular plane systolic excursion (TAPSE) could be revealed, independently of the RV pacing burden. Additionally, after 24-month long term follow-up there were no differences in LVEF and TAPSE in both groups. Accordingly, no relevant changes of peak exercise capacity, ventilatory anaerobic threshold or maximal oxygen consumption could be demonstrated independently of the RV pacing.
In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence on several echocardiographic and spiroergometric surrogate parameters of pacemaker-induced cardiomyopathy after a follow-up of 12 to 24 month. Despite this, screening for pacemaker induced cardiomyopathy should be performed especially in the presence of new heart failure symptoms.
在左心室功能正常的患者中，由于右心室（RV）起搏负荷增加导致临床转归恶化的发生率仍存在争议。
研究 RV 起搏对几种超声心动图和呼吸动力参数的影响。
在 60 例左心室射血分数（LVEF）正常的起搏器患者中，在 12 个月的时间内进行了一系列超声心动图和呼吸动力检查。此外，在 48 例患者中，在起搏器植入后长达 24 个月的时间内，对 LV 和 RV 功能进行了回顾性超声心动图分析。
根据之前的随机 MOST 和 DAVID 试验的定义，患者被分为两组：高 RV 起搏负荷组（hRVP：≥40%）和低 RV 起搏组（lRVP<40%）。在接受起搏器治疗 12 个月后，LVEDD、LVESD、LVEF、E/A 比值、E/E'比值和三尖瓣环平面收缩期位移（TAPSE）均无变化，与 RV 起搏负荷无关。此外，在 24 个月的长期随访中，两组的 LVEF 和 TAPSE 均无差异。相应地，在 RV 起搏的情况下，峰值运动能力、通气无氧阈值或最大摄氧量均无明显变化。
在左心室射血分数正常的起搏器患者中，RV 起搏负荷在 12 至 24 个月的随访中，对起搏器诱导性心肌病的几种超声心动图和呼吸动力替代参数没有不良影响。尽管如此，特别是在出现新的心力衰竭症状时，仍应进行起搏器诱导性心肌病的筛查。
