Right ventricular apical pacing acutely impairs left ventricular function and induces mechanical dyssynchrony in patients with sick sinus syndrome: a real-time three-dimensional echocardiographic study.
BACKGROUND
Chronic right ventricular apical (RVA) pacing can lead to an increased risk of heart failure. However, assessment of left ventricular mechanical dyssynchrony in the whole left ventricle simultaneously with acute RVA pacing has never been investigated.


RESULTS
This study included 35 patients with sick sinus syndrome and intact intrinsic atrioventricular conduction. All patients received dual-chamber pacemaker implants with atrial leads placed in the right atrial appendage and right ventricle leads positioned in the RVA. Transthoracic two-dimensional echocardiography, tissue Doppler echocardiography, and real-time three-dimensional echocardiography were performed to determine the chamber size, dyssynchronization index, myocardial performance index, and global left ventricular ejection fraction. The myocardial performance index was significantly higher with RVA pacing (with RVA 0.42 +/- 0.18 vs. without RVA 0.31 +/- 0.14; P = .004), and left ventricular ejection fraction derived by real-time three-dimensional echocardiography was significantly lower with RVA pacing (with RVA 54.4% +/- 7.7% vs. without RVA 56.7% +/- 7.9%; P = .013), indicating deteriorated left ventricular function with RVA pacing. In addition, there was significant difference in the intraventricular delays in favor of without RVA pacing when assessed by the septal-to-posterior wall motion delay on the midventricular level (with RVA 91.9 +/- 52.5 msec vs. without RVA 38.6 +/- 28.9 msec; P < .0001) and when assessed by real-time three-dimensional echocardiography-derived systolic dyssynchrony index (with RVA 7.00% +/- 2.54% vs. without RVA 5.36 +/- 2.17%; P = .0003).


CONCLUSIONS
Acute RVA pacing can induce left ventricular mechanical dyssynchrony and impair left ventricular function in patients with sick sinus syndrome.
Liu
Wen-Hao
WH
Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China.
Chen
Mien-Cheng
MC
Chen
Yung-Lung
YL
Guo
Bih-Fang
BF
Pan
Kuo-Li
KL
Yang
Cheng-Hsu
CH
Chang
Hsueh-Wen
HW
D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D003199:Computer Systems; D019560:Echocardiography, Three-Dimensional / Q000379:methods*; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*