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Left Ventricular Mechanical Property Changes During Acute AV Synchronous Right Ventricular Pacing in Children

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Abstract

Prolonged RV pacing is recognized as a cause of LV dysfunction due to dyssynchronous activation. There are no specific longitudinal parameters known to help predict RV pacing-induced LV dysfunction. The aim of the study was to assess the acute effects of AV synchronous RV pacing on LV mechanics using echocardiographic speckle tracking. Nineteen children, aged 6–23 years, underwent echocardiographic evaluation prior to and following elective electrophysiology and ablation studies. The subjects were evaluated in sinus rhythm and later with AV synchronous RV pacing at a cycle length of 550 ms with a short AV delay of 80 ms. The echocardiographic clips were analyzed using speckle tracking methods to calculate LV circumferential and longitudinal strain, rotation and twist in all conditions. Acute RV apical pacing decreased LV longitudinal strain from 16.1 ± 3.7 % in sinus rhythm to 14.4 ± 3.3 % (p = 0.03) and LV base rotation from −8.4° ± 3.6° to −6.4° ± 4.0° (p = 0.04). The circumferential strain, apical rotation and LV twist were not affected. Separate analysis of subjects with no prior preexcitation showed that acute RV pacing caused significant twist reduction, from 15.9° ± 7.6° to 12.1° ± 7.0° (p = 0.02), and decreased longitudinal strain and base rotation. Patients with preexcitation had abnormalities that persisted acutely after ablation. Acute RV apical pacing causes reductions in LV base rotation, longitudinal strain and twist. The recognition of abnormal LV activation patterns may provide longitudinal clues to LV dysfunction in chronically paced patients and potential novel indices of effective CRT interventions to reverse these abnormalities.

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Authors and Affiliations

  1. University of California San Diego, Rady Children’s Hospital, San Diego, CA, USA

    Shai Tejman-Yarden, Andras Bratincsak, Callie Rzasa, Beth F. Printz & James C. Perry

  2. Department of Biomedical Engineering, The Israeli Institute of Technology – the Technion, Haifa, Israel

    Noa Bachner-Hinenzon, Hanan Khamis & Dan Adam

  3. The Edmond J. Safra International Congenital Heart Center, Sheba Medical Center, Ramat Gan, Israel

    Shai Tejman-Yarden

Authors
  1. Shai Tejman-Yarden
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  2. Andras Bratincsak
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  3. Noa Bachner-Hinenzon
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  4. Hanan Khamis
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  5. Callie Rzasa
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  6. Dan Adam
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  7. Beth F. Printz
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  8. James C. Perry
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Correspondence to Shai Tejman-Yarden.

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Tejman-Yarden, S., Bratincsak, A., Bachner-Hinenzon, N. et al. Left Ventricular Mechanical Property Changes During Acute AV Synchronous Right Ventricular Pacing in Children. Pediatr Cardiol 37, 106–111 (2016). https://doi.org/10.1007/s00246-015-1246-x

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  • DOI: https://doi.org/10.1007/s00246-015-1246-x

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