This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 2/2/135    most recent CIRCEP.108.814608v2 CIRCEP.108.814608v1 Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Delgado, V. Articles by Bax, J. J. Search for Related Content PubMed PubMed Citation Articles by Delgado, V. Articles by Bax, J. J. Related Collections Contractile function Electrophysiology Echocardiography Related Article

Original Articles

Acute Effects of Right Ventricular Apical Pacing on Left Ventricular Synchrony and Mechanics

Victoria Delgado, MD; Laurens F. Tops, MD; Serge A. Trines, MD; Katja Zeppenfeld, MD, PhD; Nina Ajmone Marsan, MD; Matteo Bertini, MD; Eduard R. Holman, MD, PhD; Martin J. Schalij, MD, PhD and Jeroen J. Bax, MD, PhD

From the Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.

Correspondence to Jeroen J. Bax, MD, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail j.j.bax{at}lumc.nl

Received September 23, 2008; accepted February 2, 2009.

Background— Chronic right ventricular (RV) apical pacing has a detrimental effect on left ventricular (LV) function. However, the acute effects of RV apical pacing on LV mechanics remain unclear. The purpose of the study was to assess the acute impact of RV apical pacing on global LV function, evaluating LV contraction synchrony and LV shortening and twist, using 2D speckle-tracking strain imaging.

Methods and Results— A group of 25 patients with structural normal hearts referred for electrophysiological study were studied. Two-dimensional echocardiography was performed at baseline and during RV apical pacing at the time of the electrophysiological study. Changes in LV synchrony and mechanics (longitudinal shortening and twist) were assessed using speckle-tracking strain imaging. In addition, 25 controls matched by age, sex, and LV function were studied during sinus rhythm. The group of patients (44±12 years, 10 men) and the group of controls (48±3 years, 8 men) showed comparable LV synchrony, LV longitudinal shortening, and LV twist at baseline. However, during RV apical pacing, a more dyssynchronous LV contraction was observed in the patients (from 21 ms [Q₁:10, Q₃:53] to 91 ms [Q₁:40, Q₃:204], P<0.001) together with an impairment in LV longitudinal shortening (from –18.3±3.5% to –11.8±3.6%, P<0.001) and in LV twist (from 12.4±3.7° to 9.7±2.6°, P=0.001).

Conclusions— During RV apical pacing, an acute induction of LV dyssynchrony is observed. In addition, LV longitudinal shortening and LV twist are acutely impaired.

Key Words: mechanics • pacing • speckle-tracking imaging

---

 

CLINICAL PERSPECTIVE

Drs Delgado and Tops contributed equally to this article and are shared first author.

Related Article

Acute Effects of Right Ventricular Apical Pacing on Left Ventricular Synchrony and Mechanics

Victoria Delgado, Laurens F. Tops, Serge A. Trines, Katja Zeppenfeld, Nina Ajmone Marsan, Matteo Bertini, Eduard R. Holman, Martin J. Schalij, and Jeroen J. Bax
Circ Arrhythm Electrophysiol 2009 2: 135-145. [Abstract] [Full Text] [PDF]

This article has been cited by other articles:

				M. Bertini, P. P. Sengupta, G. Nucifora, V. Delgado, A. C.T. Ng, N. A. Marsan, M. Shanks, R. R.J. van Bommel, M. J. Schalij, J. Narula, et al. Role of Left Ventricular Twist Mechanics in the Assessment of Cardiac Dyssynchrony in Heart Failure J. Am. Coll. Cardiol. Img., December 1, 2009; 2(12): 1425 - 1435. [Abstract] [Full Text] [PDF]

				L. F. Tops, M. J. Schalij, and J. J. Bax The effects of right ventricular apical pacing on ventricular function and dyssynchrony implications for therapy. J. Am. Coll. Cardiol., August 25, 2009; 54(9): 764 - 776. [Abstract] [Full Text] [PDF]

				M. Schmidt, H. Rittger, H. Marschang, A.-M. Sinha, M. Daccarett, J. Brachmann, M. Block, and O. A. Breithardt Left ventricular dyssynchrony from right ventricular pacing depends on intraventricular conduction pattern in intrinsic rhythm Eur J Echocardiogr, August 1, 2009; 10(6): 776 - 783. [Abstract] [Full Text] [PDF]