Long-term effects of atrial synchronous ventricular pacing on systolic and diastolic ventricular function in patients with normal left ventricular ejection fraction.
BACKGROUND
Atrial synchronous right ventricular pacing (VP) may compromise ventricular function in patients undergoing pacemaker implantation for atrioventricular block. We assessed the usefulness of tissue Doppler imaging (TDI) and color M-mode echocardiography in evaluating patients with VP, and examined the long-term effects of VP on ventricular function by echocardiographic indices and B-type natriuretic peptide (BNP) measurements.


METHODS
We studied 60 clinically stable elderly dual-chamber pacemaker recipients (mean age: 74 +/- 9 years) who had normal left ventricular (LV) systolic function and on the long term the same cardiac rhythm, either intrinsic normal ventricular activation (IA) (n = 20), or VP (n = 40).


RESULTS
Paced patients, compared to patients with IA, had decreased stroke volume (p < 0.05) and a more depressed relaxation pattern, as indicated by decreased peak early mitral velocity (E)/peak atrial contraction velocity ratio and tissue Doppler imaging (TDI)-early transmitral diastolic velocity (Ea) measures (p < 0.05). Both groups presented similar BNP levels and LV filling pressures, as assessed by E/Ea and E/early diastolic transmitral flow propagation velocity. In VP patients, age (beta = 0.31), Ea (beta = -0.28) and E/Ea (beta = 0.32) emerged as independent predictors of BNP levels.


CONCLUSIONS
VP is associated with reduced LV systolic function and signs of impaired relaxation. Elevated BNP levels in elderly VP patients with normal ejection fraction may be predicted by TDI signs of LV diastolic dysfunction.
Chiladakis
John A
JA
Department of Cardiology, Patras University Hospital, Patras, Greece. chil@otenet.gr
Koutsogiannis
Nikolaos
N
Kalogeropoulos
Andreas
A
Alexopoulos
Dimitrios
D
D000368:Aged; D054537:Atrioventricular Block / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013318:Stroke Volume; D013599:Systole; D018754:Ventricular Dysfunction / Q000000981:diagnostic imaging / Q000209:etiology*; D016276:Ventricular Function
D020097:Natriuretic Peptide, Brain