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Impact of right ventricular lead position on left ventricular functions and early remodeling in permanent single- and dual-chamber pacemakers

Einfluss der rechtsventrikulären Elektrodenposition auf linksventrikuläre Funktionen und frühes Remodeling bei permanenten Ein- und Zweikammerschrittmachern

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Abstract

Background

Right ventricular (RV) apical pacing can induce both interventricular dyssynchrony and intraventricular dyssynchrony. Mechanical dyssynchrony after long-term RV apical pacing is associated with reduced left ventricular (LV) systolic function and deterioration in functional capacity.

Aim

We aimed to identify the short-term effects of the pacemaker RV lead position on remodeling of LV systolic functions.

Patients and methods

The study included 30 patients who presented with an indication of permanent pacing and who underwent permanent single- or dual-chamber pacemaker insertion: 15 patients with RV apical pacing (RV apex), and 15 patients with non-apical pacing (mid-septal). The two-dimensional (2D) speckle tracking imaging technique was used for quantification of global longitudinal function of the left ventricle and dyssynchrony evaluation before pacemaker implantation and after a 3-month follow-up.

Results

At the 3‑month follow-up, post-pacing 2D speckle tracking echocardiography revealed impairment of global longitudinal strain in all patients and intraventricular dyssynchrony was significantly increased in the apical location compared with the non-apical location (radial dyssynchrony: 108.67 ± 11.68 ms vs. 80.53 ± 8.17 ms, p < 0.001) with a greater difference (50.53 ± 13.30 ms) in the apical location than in the non-apical location (29.87 ± 6.64 ms, p < 0.001).

Conclusion

In the short-term follow-up, 2D speckle tracking echocardiography showed more radial dyssynchrony in the apical location than in the non-apical location of RV lead. The RV septal pacing is a better alternative in terms of less dyssynchrony compared to RV apical pacing. Older age, higher percentage of pacing, and device type are prognostic factors for development of pacemaker-induced cardiomyopathy.

Zusammenfassung

Hintergrund

Durch rechtsventrikuläre (RV) apikale Schrittmachertherapie kann sowohl eine interventrikuläre Dyssynchronie als auch eine intraventrikuläre Dyssynchronie ausgelöst werden. Eine mechanische Dyssynchronie nach apikaler Langzeit-RV-Schrittmachertherapie geht mit einer verminderten linksventrikulären (LV) systolischen Funktion und Verschlechterung der funktionellen Kapazität einher.

Ziel

Ziel der Arbeit war es, die kurzfristigen Auswirkungen der RV-Elektrodenposition des Schrittmachers auf das Remodeling systolischer LV-Funktionen zu ermitteln.

Patienten und Methoden

In die Studie wurden 30 Patienten einbezogen, die sich mit einer Indikation für eine permanente Schrittmachertherapie vorstellten und bei denen die Implantation eines permanenten Ein- oder Zweikammerschrittmachers erfolgte: 15 Patienten mit apikaler RV-Schrittmachertherapie (RV-Apex) und 15 Patienten mit nichtapikaler Schrittmachertherapie (mittseptal). Die zweidimensionale (2-D-)Speckle-Tracking-Echokardiographie wurde zur Quantifizierung der globalen longitudinalen Funktion des LV und zur Beurteilung einer Dyssynchronie vor der Schrittmacherimplantation und nach 3‑monatiger Nachbeobachtung eingesetzt.

Ergebnisse

Bei der Nachuntersuchung nach 3 Monaten zeigte sich in der 2‑D-Speckle-Tracking-Echokardiographie nach Schrittmachertherapie eine Beeinträchtigung des globalen longitudinalen Strains bei allen Patienten, und die intraventrikuläre Dyssynchronie war bei apikaler Lokalisation signifikant größer als bei nichtapikaler Lokalisation (radiale Dyssynchronie: 108,67 ± 11,68 ms vs. 80,53 ± 8,17 ms; p < 0,001), es bestand ein größerer Unterschied (50,53 ± 13,30 ms) bei apikaler Lokalisation als bei nichtapikaler Lokalisation (29,87 ± 6,64 ms; p < 0,001).

Schlussfolgerung

Im Rahmen der kurzfristigen Nachbeobachtung ergab die 2‑D-Speckle-Tracking-Echokardiographie eine stärkere radiale Dyssynchronie bei apikaler Lokalisation als bei nichtapikaler Lokalisation der RV-Elektrode. Die septale RV-Schrittmachertherapie stellt eine bessere Alternative in Bezug auf eine geringere Dyssynchronie im Vergleich zur apikalen RV-Schrittmachertherapie dar. Höheres Alter, ein höherer Anteil an Schrittmacheraktionen und der Gerätetyp sind prognostische Faktoren hinsichtlich der Entstehung einer schrittmacherinduzierten Kardiomyopathie.

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Abbreviations

BMI:

body mass index

CHB:

complete heart block

DM:

diabetes mellitus

ECG:

electrocardiogram

EF:

ejection fraction

GLS:

global longitudinal strain

HD:

high degree

HS:

highly significant

HTN:

hypertension

LV:

left ventricle

LVEF:

left ventricular ejection fraction

NS:

non-significant

NYHA:

The New York Heart Association functional classification

PICM:

pacing-induced cardiomyopathy

RV:

right ventricle

S:

significant

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Funding

This study was not funded by any companies.

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Ahmed Nabil Ali MD, Ahmed Nabih Hawas MSc, Ahmed Yehia Ramadan MD & Ahmed Fathy Tamara MD

Authors
  1. Ahmed Nabil Ali MD
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  2. Ahmed Nabih Hawas MSc
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  3. Ahmed Yehia Ramadan MD
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  4. Ahmed Fathy Tamara MD
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Corresponding author

Correspondence to Ahmed Nabil Ali MD.

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Conflict of interest

A.N. Ali, A.N. Hawas, A.Y. Ramadan and A.F. Tamara declare that they have no competing interests.

This study was approved by Ain Shams University ethical committee according to the ethical guidelines of the 1975 declaration of Helsinki as revised in 2008. An informed consent was obtained from all patients prior to their inclusion in the study.

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Copyrights: All authors ensure their acceptance of transfer of copyright to the journal Herzschrittmachertherapie und Elektrophysiologie upon the acceptance of the manuscript for publication.

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Ali, A.N., Hawas, A.N., Ramadan, A.Y. et al. Impact of right ventricular lead position on left ventricular functions and early remodeling in permanent single- and dual-chamber pacemakers. Herzschr Elektrophys 33, 432–439 (2022). https://doi.org/10.1007/s00399-022-00896-2

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  • DOI: https://doi.org/10.1007/s00399-022-00896-2

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