Dynamic and site-specific impact of ventricular pacing on left ventricular ejection fraction.
BACKGROUND
Some studies suggest that right ventricular (RV) pacing has an adverse impact on left ventricular ejection fraction (LVEF), particularly in subjects with preexisting left ventricular (LV) dysfunction, and that direct LV pacing may be relatively protective. Interactions between pacing site and LVEF remain unclear.


OBJECTIVE
The purpose of this study was to examine the relative impact of RV and LV pacing on LVEF by serial study during a period in which LV dysfunction, induced by tachypacing, was introduced and then resolved.


METHODS
In each of five dogs, RV, LV, and simultaneous RV and LV (BiV) pacing modes were compared to native ventricular activation (1) prior to tachypacing (baseline), (2) weekly during a 5-week continuous tachypacing period, and (3) weekly during a 3-week post-tachypacing recovery period. At each evaluation, LVEF and LV contraction synchrony were assessed during each pacing mode.


RESULTS
The decrease in LVEF during the tachypacing period was more pronounced during RV pacing than during native activation or LV or BiV pacing. The magnitude of this effect correlated with a diminishment in LV contraction synchrony that was not observed during native activation or LV or BiV pacing. During the post-tachypacing period, gradual reversal of these changes toward baseline was observed.


CONCLUSIONS
Compared to native activation, RV pacing worsens LVEF in a manner proportional to the severity of preexisting LV dysfunction, attributable to reduced LV contraction synchrony. In comparison, both LV and BiV pacing preserve LVEF and contraction synchrony.
Schwartzman
David
D
Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. schwartzmand@upmc.edu
Johnson
Lauren
L
Tanaka
Hidekazu
H
Ota
Takeyoshi
T
Gorcsan
John
J
Lamia
Bouchra
B
Pinsky
Michael R
MR
Shroff
Sanjeev G
SG
D000704:Analysis of Variance; D000818:Animals; D002304:Cardiac Pacing, Artificial; D004285:Dogs; D004562:Electrocardiography; D006325:Heart Atria / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology*; D009200:Myocardial Contraction; D013223:Statistics as Topic; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology*; D016277:Ventricular Function, Left