Unfavourable effects of continuous, atrial-synchronised ventricular pacing on ventricular systolic and diastolic function in patients with normal left ventricular ejection fraction: usefulness of tissue and colour Doppler echocardiography.
BACKGROUND
Conventional, atrial-synchronised, right ventricular apical pacing (VP) may compromise ventricular function by causing ventricular desynchronisation. The aim of this study was to evaluate the long-term effects of VP on left and right ventricular systolic and diastolic function.


METHODS
We studied 21 clinically stable dual-chamber pacemaker recipients (mean age 68 +/- 9 years) with normal left ventricular (LV) systolic function. Patients were in long-term sinus rhythm and had intrinsic ventricular activation with narrow QRS complexes. In an intrapatient model, baseline echocardiographic and tissue Doppler imaging (TDI), colour M-Mode (CMM) examinations, as well as plasma B-type natriuretic peptide (BNP) data, were compared to corresponding measurements following a 3-month period of continuous VP.


RESULTS
Following VP we noted significant increases in LV end-systolic volume (p < 0.001) and isovolumic relaxation time (p < 0.05), as well as a significant decline in LV systolic function based on ejection fraction (p < 0.001) and TDI-Sa (p < 0.05). VP was associated with worse LV diastolic function, based on CMM-Vp (p < 0.05) and increased E/Vp ratio (p < 0.05), but with similar E/Ea ratio and BNP levels (p: NS).


CONCLUSIONS
VP appears to impair LV systolic and diastolic function and may predispose to higher LV filling pressures.
Chiladakis
John A
JA
Cardiology Department, Patras University Hospital, Greece. chil@otenet.gr
Koutsogiannis
Nikolaos
N
Kalogeropoulos
Andreas
A
Zagli
Fani
F
Arvanitis
Panagiotis
P
Alexopoulos
Dimitrios
D
D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003971:Diastole; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology*
D020097:Natriuretic Peptide, Brain