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ȣ - 550485 11 |
Effect of Cumulative Right Ventricular Apical Pacing on Ventricular Function and Remodeling |
가톨릭대학교 의과대학 내과학교실 |
김태석, 윤호중, 오용석, 정해억, 조은주, 장성원, 박찬석, 정우백, 최민석, 안서희, 정수연, 이정은, 진정연, 강민규, 황병희, 이만영, 노태호 |
Background: The aim of this study was to evaluate whether cumulative right ventricular apical pacing (RVAP) in patients with permanent pacemaker (PPM) implantation influence ventricular function and remodeling.
Methods: We performed echocardiography before and after PPM implantation to 87 patients (50 females, mean age: 68.3±1.4 years, 51 sick sinus syndromes, 36 atrioventricular blocks, median follow-up duration: 26.2 months). Subjects were divided into infrequent (0-50%) pacing group and frequent (51-100%) pacing group with median pacing rate 1.0% and 99.7%, respectively. Echocardiographic parameters including the interventricular dyssynchrony (IVDS) were assessed to evaluate ventricular function and remodeling. IVDS was calculated as the difference between the pre-ejection intervals from the QRS onset to the beginning of ventricular ejection at the right and left ventricular outflow tract.
Results: LV ejection fraction (LVEF) was more decreased in frequent pacing group than in infrequent pacing group (-7.2±5.6% vs.-2.52±9.26%, p=0.017). The frequent pacing group showed significant IVDS prolongation than infrequent pacing group (23.8±30.1 msec vs. 5.3±16.5 msec, p=0.001). The changes of echocardiographic parameters of RV remodeling and function showed no significant differences between before and after PPM implantation in two groups (Table).
Conclusion: Frequent RVAP decreases LVEF but may not affect the RV function and remodeling, although IVDS significantly prolonged.
Key words: apical pacing, remodeling, ventricular function, dyssynchrony
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Table. Difference values of echocardiographic parameters between before and after PPM implantation |
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Cumulative pacing 0-50% (n=46) |
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Cumulative pacing 51-100% (n=41) |
p |
LVEF (%) |
-2.52 ± 9.26 |
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-7.17 ± 8.55 |
0.017 |
LVEDD (mm) |
-1.78 ± 6.67 |
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-1.21 ± 4.58 |
0.649 |
LVESD (mm) |
0.03 ± 4.98 |
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0.92 ± 4.68 |
0.397 |
LVEDV (mL) |
-4.99 ± 18.89 |
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-2.64 ± 24.82 |
0.619 |
LVESV (mL) |
-0.25 ± 10.00 |
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5.85 ± 15.16 |
0.028 |
E/e´ |
0.24 ± 5.56 |
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-1.12 ± 4.81 |
0.231 |
RV dimension (mm) |
-1.48 ± 4.44 |
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-1.92 ± 5.79 |
0.693 |
RV end-diastolic area (cm2) |
-0.54 ± 1.94 |
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0.04 ± 3.91 |
0.392 |
RV end-systolic area (cm2) |
-0.54 ± 1.94 |
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0.22 ± 2.37 |
0.566 |
RV fractional area change (%) |
-1.04 ± 13.84 |
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-0.73 ± 12.55 |
0.914 |
Interventricular dyssynchrony (msec) |
5.33 ± 16.53 |
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23.78 ± 30.07 |
0.001 |
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