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Intramural Dyssynchrony from Acute Right Ventricular Apical Pacing in Human Subjects with Normal Left Ventricular Function

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Abstract

Ventricular pacing causes early myocardial shortening at the pacing site and pre-stretch at the opposing ventricular wall. This contraction pattern is energetically inefficient and may lead to decreased cardiac function. This study was designed to describe the acute effects of right ventricular apical (RVa) pacing on dyssynchrony and systolic function in human subjects with normal left ventricular (LV) function and compare these effects to pacing from alternate ventricular sites. Patients (n = 26) undergoing an electrophysiology evaluation were studied during atrial pacing (AAI) and dual chamber pacing from the RVa, left ventricular free wall (LVfw), and the combination of RVa and LVfw (BiV). Tissue Doppler imaging was used to measure intramural dyssynchrony by utilizing an integrated cross-correlation synchrony index (CCSI) from the apical 4-chamber view. RVa and BiV pacing significantly reduced systolic function as measured by longitudinal systolic contraction amplitude (SCAlong) (p < 0.05) and LV velocity time integral (VTI) (p < 0.05) compared to AAI and LVfw pacing. RVa (and to a lesser extent BiV) pacing resulted in septal and lateral intramural dyssynchrony as indicated by significantly (p < 0.05) lower CCSI values as compared to AAI. CCSI was significantly (p < 0.05) worse during RVa than LVfw pacing. In patients with normal LV function, acute ventricular pacing in the RVa alone, or in conjunction with LVfw pacing (BiV), results in impaired regional and global LV systolic function and intramural dyssynchrony as compared to LVfw pacing alone.

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Funding Source

This study was funded by Medtronic, Inc., Minneapolis, Minnesota.

Disclosures

Dr. Bank receives honoraria and research grant support from Medtronic and Boston Scientific. Dr. Schwartzman is a consultant and receives research grant support from Medtronic and receives grant support from St. Jude Medical. Mr. Burns and Dr. Johnson have no disclosures. Dr. Kaufman received honoraria and research grant support from Medtronic and Boston Scientific. Dr. Adler receives honoraria and research grant support from Medtronic, Boston Scientific and St. Jude Medical. Dr. Kelly received research grant support from Medtronic and Boston Scientific. Dr. Kaiser was formerly an employee of Medtronic.

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Authors and Affiliations

  1. St. Paul Heart Clinic, 225 N. Smith Ave, Suite 400, St. Paul, MN, 55102, USA

    Alan J. Bank, David S. Schwartzman, Kevin V. Burns, Christopher L. Kaufman, Stuart W. Adler & Aaron S. Kelly

  2. Cardiovascular Institute, University of Pittsburgh, Pittsburgh, PA, USA

    David S. Schwartzman & Lauren Johnson

  3. CRDM Research, Medtronic Inc, Minneapolis, MN, USA

    David S. Schwartzman & Daniel R. Kaiser

Authors
  1. Alan J. Bank
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  2. David S. Schwartzman
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  3. Kevin V. Burns
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  4. Christopher L. Kaufman
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  5. Stuart W. Adler
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  6. Aaron S. Kelly
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  7. Lauren Johnson
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  8. Daniel R. Kaiser
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Correspondence to Alan J. Bank.

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Bank, A.J., Schwartzman, D.S., Burns, K.V. et al. Intramural Dyssynchrony from Acute Right Ventricular Apical Pacing in Human Subjects with Normal Left Ventricular Function. J. of Cardiovasc. Trans. Res. 3, 321–329 (2010). https://doi.org/10.1007/s12265-010-9176-8

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  • DOI: https://doi.org/10.1007/s12265-010-9176-8

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