Alterations in Myocardial Perfusion and Regional Wall Motion in Patients with Permanent Pacemaker

Cha, Kwang Soo; Min, Jung Jun; Kim, Ju Han; Kim, Jun Woo; Kim, Sung Hee; Bae, Youl; Ahn, Young Keun; Park, Jong Cheol; Seo, Jeong Pyeong; Park, Joo Hyung; Jeong, Myung Ho; Bom, Hee Seung; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND
The effect of right ventricular pacing on myocardial perfusion and regional wall motion is not well known, although some studies have suggested that it may be adverse. We investigated the effects of right ventricular pacing on myocardial perfusion and regional wall motion in patients with permanent pacemakers. METHOD: Thirty patients receiving permanent pacemakers for complete heart block or sick sinus syndrome were included in this study. All the patients showed normal coronary angiograms. Myocardial scintigraphy and two-dimensional echocardiography were performed to assess myocardial perfusion and to evaluate regional wall motion and global function of the left ventricle (LV).
RESULTS
1) Mean age was 66.2+/-8.2 (41-84) years, and the male-to-female ratio was 1 : 1.7 (11 male, 19 female). Indications for permanent pacemaker implantation were complete atrioventricular (AV) block in 21 patients and sick sinus syndrome in 9. The selected pacing modes were VVI in 14 patients, DDD in 8, VDD in 6, and AAI in 2. LV ejection fraction estimated by 2-dimensional echocardiography was 62.7+/-5.8 (53-86)%. 2) Perfusion defects were noted in 26 (87%) patients including 25 (89%) out of 28 patients with ventricular pacing modes such as VVI, DDD, and VDD, and 1 (50%) out of 2 patients with AAI mode. Locations of perfusion defects were septal in 19 (63%) patients, inferior in 17 (57%), apical in 16 (53%), lateral in 3 (10%), and anterior in 2 (7%). Extent of maximal perfusion defects was 17.0+/-9.5 (0-44)%. 3) Regional wall motion abnormalities were noted mainly over the apical region of the LV in 26 (93%) of 28 patients with ventricular pacing. However, LV ejection fraction did not differ significantly before and early after implantation of the pacemaker (62.7+/-5.8% vs. 61.0+/-5.8%, p-0.313).
CONCLUSIONS
Right ventricular apical pacing frequently caused myocardial perfusion defects and regional wall motion abnormalities. These might be due to abnormal ventricular activation and abnormal interventricular septal motion. The long-term effects of these abnormalities remain to be determined, and the pacing technique to minimize these adverse effects should be developed.