Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 32-36, January 2006

Acute Effects of Dual-chamber Pacing on the Left Ventricular Systolic Function and Relaxation in Patients with Advanced AV Block and Sick Sinus Syndrome

  • Hsiang-Chiang Hsiao

      Affiliations

    • Division of Cardiology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chen-Huan Chen

      Affiliations

    • National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Chen-Huan Chen, Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.
    • ,
  • Chi-Woon Kong

      Affiliations

    • National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.
    • ,
  • Chun-Peng Liu

      Affiliations

    • Division of Cardiology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taipei, Taiwan, R.O.C.
    • National Yang-Ming University School of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C.

Received 22 March 2005; accepted 22 November 2005.

Article Outline

Background

Abnormal activation of the ventricles via right ventricular apical pacing deteriorates cardiac function, which may explain the increased mortality of patients with congestive heart failure receiving permanent pacemakers. We hypothesized that pacing at alternative sites may cause less detrimental effects on the cardiac function.

Methods

Five symptomatic patients with either advanced AV block (n = 4) or sick sinus syndrome with normal left ventricular (LV) function (n = 1) were studied. During cardiac catheterization, LV pressure was recorded with a high-fidelity catheter-tipped transducer. Baseline rhythms were sinus rhythm or VVI pacing. Sequential VDD pacing with variable AV intervals was performed at the right ventricular apex (RVA), right ventricular septum (RVS), right ventricular outflow tract (RVOT) and coronary sinus (CS). LV systolic function was assessed by calculating dP/dtmax and LV diastolic function was indexed by calculating the exponential isovolumic relaxation constant (Tau). Percentage changes (mean ± SE) from baseline to pacing were measured.

Results

RVA pacing reduced dP/dtmax (-0.8 ± 8.4%) and prolonged Tau (7.0 ± 5.6%); RVS pacing enhanced dP/dtmax (20.7 ± 15.3%) and shortened Tau (-10.4 ± 9%); RVOT pacing reduced dP/dtmax (-8.0 ± 20.0%) and shortened Tau (-6.0 ± 12.2%); CS pacing reduced dP/dtmax (-11.7 ± 13.0%) and prolonged Tau (10.5 ± 11.9%). Our results demonstrated that different pacing sites have different effects on LV contractility and relaxation in patients with normal LV function.

Conclusion

Since pacing at the RVS preferably increased LV dP/dtmax and shortened Tau, it may be a better alternative than the RVA.

Key Words:  left ventricular function , left ventricular relaxation , pacing therapy

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References 

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PII: S1726-4901(09)70108-X

doi:10.1016/S1726-4901(09)70108-X

Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 32-36, January 2006

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