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Dyssynchrony, contraction efficiency and regional function with apical and non-apical RV pacing

journal contribution
posted on 2023-05-18, 08:04 authored by Saito, M, Kaye, G, Kazuaki Negishi, Linker, N, Gammage, M, Wojciech KosmalaWojciech Kosmala, Thomas MarwickThomas Marwick

Background: Recent work has shown no difference in change of LVEF between RV apical (RVA) pacing and non-RVA pacing in patients with normal LV function. We hypothesised that a more sensitive marker (global longitudinal strain, GLS) could identify a detrimental effect of RVA and that assessment of deformation could identify whether dyssynchrony, contraction inefficiency and regional LV impairment were responsible for functional changes.

Methods: In this substudy of Protect-PACE (The Protection of Left Ventricular Function During Right Ventricular Pacing. Does Right Ventricular High-septal Pacing Improve Outcome Compared With Right Ventricular Apical Pacing?), a randomised controlled trial of RVA and non-RVA pacing in pacemaker-dependent patients with preserved EF, 145 patients (76 with RVA) with echocardiograms of sufficient quality underwent measurement of LV longitudinal strain (GLS) from speckle tracking just after implantation and at 2 years. LV dyssynchrony, discoordination and regional apical longitudinal strain were also measured.

Results: Pacing was associated with reduced GLS after 2 years, although 2-year GLS was lower in RVA (-13.9 ± 4.1 vs -15.5 ± 4.6, p = 0.02). RVA was an independent correlate of ΔGLS, although there was a minor difference in ΔGLS between the RVA and non-RVA groups (-1.8 ± 3.6 vs -0.8 ± 3.4%, p = 0.07), reflecting impairment of GLS at baseline in RVA. Apical strain was significantly lower in RVA than those in non-RVA at baseline and 2 years (both p < 0.01). Dyssynchrony and discoordination parameters at 2 years also showed significant deterioration in RVA. Apical strain, dyssynchrony and discoordination parameters at 2 years were significantly associated with ΔGLS.

Conclusions: Inefficient dyssynchronous contraction and the decrease in apical strain appear to be associated with global LV impairment in RVA.

History

Publication title

Heart

Volume

101

Issue

8

Pagination

600-608

ISSN

1355-6037

Department/School

Menzies Institute for Medical Research

Publisher

BMJ Publishing Group

Place of publication

British Med Assoc House, Tavistock Square, London, England, Wc1H 9Jr

Rights statement

Copyright 2015 Copyright Article author (or their employer)

Repository Status

  • Restricted

Socio-economic Objectives

Clinical health not elsewhere classified

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