Ventricular remodeling in right ventricular apical pacing.
OBJECTIVE
To determine ventricular remodeling (VR) and the role of clinical and functional variables in patients with normal cardiac function who underwent right ventricular apical pacing (RVAP).


METHODS
Among the 268 consecutive patients with standard pacemaker due to complete atrioventricular block (CAVB), those with left ventricular ejection fraction (LVEF) < 55% and left ventricular end-diastolic diameter (LVEDD) > 53 mm on Doppler echocardiography were excluded. Ventricular remodeling was defined as echocardiographic changes documented at least six months after implantation, namely, a >10% increase in LVEDD and a > 20% decrease in LVEF. The following variables were analyzed: underlying heart disease, NYHA functional class of heart failure (HF), time of ventricular stimulation, and QRS duration. Statistical analysis included likelihood ratio test, Fishers exact test, and Wilcoxon rank-sum test. A p value < 0.05 was considered statistically significant.


RESULTS
The study included 75 patients, mean age 70.9 +/- 14, of whom 22.6% were male. Mean time between both evaluations was 80.2 months. Before implantation, mean LVEF was 72% and LVEDD was 46 mm; after implantation this values were 69.7% (p = 0.0025) and 48.5 mm (p = 0.0001), respectively. Mean QRS duration after implantation was 156 ms. Ventricular remodeling was observed only in four patients (5.3%), and no exploratory variable specified this behavior.


CONCLUSIONS
In a long-term follow-up, patients without ventricular dysfunction who underwent RV apical pacing (RVAP) showed low VR rate, and no analyzed variable was associated with its occurrence.
Silva
Rodrigo Tavares
RT
Hospital das Clínicas Heart Institute, FMUSP, São Paulo, SP, Brazil. rotasil@ig.com.br
Martinelli Filho
Martino
M
de Oliveira
Júlio César
JC
de Lima
Carlos Eduardo Batista
CE
Martins
Daniela Garcia Moreno Cabral
DG
Guirao
Cinthya Ibraim
CI
Nishióka
Silvana Angelina Dório
SA
Costa
Roberto
R
Sosa
Eduardo Argentino
EA
Ramires
José Antonio Franchini
JA
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012720:Severity of Illness Index; D016277:Ventricular Function, Left / Q000502:physiology; D020257:Ventricular Remodeling / Q000502:physiology*