title: Ventricular remodeling during long-term right ventricular pacing following His bundle ablation.
abstract: To investigate ventricular remodeling during long-term right ventricular (RV) pacing after His bundle ablation (HBA) in patients with atrial arrhythmias, a retrospective analysis was performed on echocardiographic data from 45 patients (mean age 57 +/- 11 years) with atrial arrhythmias who underwent HBA and pacemaker implantation (HBA-PI) to control ventricular rate. Echocardiography was performed 1 year before HBA-PI, and up to 7 +/- 2 years of follow-up was conducted. An inverse linear relation was found between the relative increase of left ventricular (LV) end-diastolic diameter (EDD) during long-term RV pacing and LVEDD before HBA-PI (r = -0.61, p<0.001). Patients were divided into 2 groups: those with LVEDDs smaller than the mean LVEDD of 50 mm (group I, 46 +/- 2 mm, n = 28) and those with LVEDDs >50 mm (group II, 56 +/- 4 mm, n = 17). Before HBA-PI, patients in group I had significantly smaller LV weights (167 +/- 44 vs 238 +/- 56 g) and LV end-systolic diameters (30 +/- 2 vs 42 +/- 7 mm) and higher LV ejection fractions (64 +/- 5% vs 49+/- 12%) than those in group II. In group I, long-term RV pacing increased LVEDD, LV end-systolic diameter, LV weight, and left atrial diameter; increased mitral regurgitation; and decreased the LV ejection fraction and LV fractional shortening. No significant changes were observed during long-term RV pacing in group II. In conclusion, long-term RV pacing after HBA adversely affects LV structure and function in patients with initially normal LV dimensions and function.
authors.affiliation: Department of Cardiology, Cardiovascular Research Institute Maastricht, University Hospital Maastricht, Maastricht, The Netherlands. k.vernooy@fys.unimaas.nl
authors.forename: Kevin
authors.initials: K
authors.lastname: Vernooy
authors.forename: Barbara
authors.initials: B
authors.lastname: Dijkman
authors.forename: Emile C
authors.initials: EC
authors.lastname: Cheriex
authors.forename: Frits W
authors.initials: FW
authors.lastname: Prinzen
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
mesh_terms: D001145:Arrhythmias, Cardiac / Q000628:therapy; D002036:Bundle of His / Q000601:surgery*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D017115:Catheter Ablation; D003971:Diastole / Q000502:physiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging; D010138:Pacemaker, Artificial / Q000009:adverse effects; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D013599:Systole / Q000502:physiology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology / Q000628:therapy*; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*