J Cardiovasc Ultrasound.  2012 Mar;20(1):42-48. 10.4250/jcu.2012.20.1.42.

Impact of Right Ventricular Apical Pacing and Its Frequency on Left Atrial Function

• Choi BJ
• Cho KI
• Kim SM
• Song YJ
• Lee HG
• Kim TI

• KMID: 2177340
• DOI: http://doi.org/10.4250/jcu.2012.20.1.42

Abstract

BACKGROUND
Right ventricular apical (RVA) pacing induces left ventricular (LV) dyssynchrony, increases the risk of persistent atrial fibrillation in the long term. The aim was to investigate the effects of RVA pacing on left atrial (LA) function, which are unknown.
METHODS
Echocardiographic evaluation including LV dyssynchrony based on conventional Doppler, tissue Doppler imaging and speckle tracking strain echocardiography was done before and after (12 months) single-chamber ventricular pacemaker implantation in 40 patients with sick sinus syndrome. Patients were divided to 2 groups, according to the RVA pacing frequency (group I had higher pacing rate of more than 50% and group II, less than 50%).
RESULTS
There was no significant difference in LV ejection fraction, however, mean global LV strain, myocardial performance index, and parameters of LV dyssynchrony had shown significant changes after 12 months of RVA pacing. There were also significant increase in the LA volume index and the reduction of peak systolic LA strain and strain rate (SR), peak early and late diastolic SR after RVA pacing. Moreover, there was significant deterioration of LV dyssynchrony and both LA and LV longitudinal function in even group II. LA functional deterioration and LA volume was significantly correlated with the frequency of RVA pacing.
CONCLUSION
LV dyssynchrony, induced by RVA pacing, significantly impaired active LA contraction and passive stretching, and these findings were shown in the patients with even less than 50% of RVA pacing. Impairment of LA strain/SR was significantly correlated with the frequency of RVA pacing.

Keyword

Atrial function; Pacemaker; Dyssynchrony

MeSH Terms

Atrial Fibrillation
Atrial Function
Atrial Function, Left
Contracts
Echocardiography
Humans
Muscle Stretching Exercises
Sick Sinus Syndrome
Sprains and Strains
Track and Field

Reference

1. Schmidt M, Brömsen J, Herholz C, Adler K, Neff F, Kopf C, Block M. Evidence of left ventricular dyssynchrony resulting from right ventricular pacing in patients with severely depressed left ventricular ejection fraction. Europace. 2007. 9:34–40.

2. Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA. MOde Selection Trial Investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation. 2003. 107:2932–2937.

3. Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A. Dual Chamber and VVI Implantable Defibrillator Trial Investigators. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA. 2002. 288:3115–3123.

4. Steinberg JS, Fischer A, Wang P, Schuger C, Daubert J, McNitt S, Andrews M, Brown M, Hall WJ, Zareba W, Moss AJ. MADIT II Investigators. The clinical implications of cumulative right ventricular pacing in the multicenter automatic defibrillator trial II. J Cardiovasc Electrophysiol. 2005. 16:359–365.

5. van Oosterhout MF, Prinzen FW, Arts T, Schreuder JJ, Vanagt WY, Cleutjens JP, Reneman RS. Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall. Circulation. 1998. 98:588–595.

6. Karpawich PP, Rabah R, Haas JE. Altered cardiac histology following apical right ventricular pacing in patients with congenital atrioventricular block. Pacing Clin Electrophysiol. 1999. 22:1372–1377.

7. Vernooy K, Dijkman B, Cheriex EC, Prinzen FW, Crijns HJ. Ventricular remodeling during long-term right ventricular pacing following His bundle ablation. Am J Cardiol. 2006. 97:1223–1227.

8. Barold SS, Ovsyshcher IE. Pacemaker-induced mitral regurgitation. Pacing Clin Electrophysiol. 2005. 28:357–360.

9. Maurer G, Torres MA, Corday E, Haendchen RV, Meerbaum S. Two-dimensional echocardiographic contrast assessment of pacing-induced mitral regurgitation: relation to altered regional left ventricular function. J Am Coll Cardiol. 1984. 3:986–991.

10. Nishikage T, Nakai H, Lang RM, Takeuchi M. Subclinical left ventricular longitudinal systolic dysfunction in hypertension with no evidence of heart failure. Circ J. 2008. 72:189–194.

11. Cho GY, Song JK, Park WJ, Han SW, Choi SH, Doo YC, Oh DJ, Lee Y. Mechanical dyssynchrony assessed by tissue Doppler imaging is a powerful predictor of mortality in congestive heart failure with normal QRS duration. J Am Coll Cardiol. 2005. 46:2237–2243.

12. Cho KI, Lee HG, Ak SJ, Huh JE, Kim HJ, Moon JY, Park KM, Kim TI. Quantitative assessment of left atrial functional changes in patients with atrial fibrillation by tissue Doppler strain and 2-dimensional strain imaging. Korean Circ J. 2006. 36:786–793.

13. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, Tajik AJ, Seward JB. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. J Cardiol. 1995. 26:357–366.

14. Cazeau S, Bordachar P, Jauvert G, Lazarus A, Alonso C, Vandrell MC, Mugica J, Ritter P. Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study. Pacing Clin Electrophysiol. 2003. 26:137–143.

15. Bax JJ, Marwick TH, Molhoek SG, Bleeker GB, van Erven L, Boersma E, Steendijk P, van der Wall EE, Schalij MJ. Left ventricular dyssynchrony predicts benefit of cardiac resynchronization therapy in patients with end-stage heart failure before pacemaker implantation. Am J Cardiol. 2003. 92:1238–1240.

16. Tops LF, Suffoletto MS, Bleeker GB, Boersma E, van der Wall EE, Gorcsan J 3rd, Schalij MJ, Bax JJ. Speckle-tracking radial strain reveals left ventricular dyssynchrony in patients with permanent right ventricular pacing. J Am Coll Cardiol. 2007. 50:1180–1188.

17. Prinzen FW, Peschar M. Relation between the pacing induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol. 2002. 25:484–498.

18. Connolly SJ, Kerr CR, Gent M, Roberts RS, Yusuf S, Gillis AM, Sami MH, Talajic M, Tang AS, Klein GJ, Lau C, Newman DM. Effects of physiologic pacing versus ventricular pacing on the risk of stroke and death due to cardiovascular causes. Canadian Trial of Physiologic Pacing Investigators. N Engl J Med. 2000. 342:1385–1391.

19. Cho GY, Kim MJ, Park JH, Kim HS, Youn HJ, Kim KH, Song JK. Comparison of ventricular dyssynchrony according to the position of right ventricular pacing electrode: a multi-center prospective echocardiographic study. J Cardiovasc Ultrasound. 2011. 19:15–20.

20. Toff WD, Camm AJ, Skehan JD. United Kingdom Pacing and Cardiovascular Events Trial Investigators. Single-chamber versus dual-chamber pacing for high-grade atrioventricular block. N Engl J Med. 2005. 353:145–155.

21. Healey JS, Toff WD, Lamas GA, Andersen HR, Thorpe KE, Ellenbogen KA, Lee KL, Skene AM, Schron EB, Skehan JD, Goldman L, Roberts RS, Camm AJ, Yusuf S, Connolly SJ. Cardiovascular outcomes with atrial-based pacing compared with ventricular pacing: meta-analysis of randomized trials, using individual patient data. Circulation. 2006. 114:11–17.

22. Tsang TS, Barnes ME, Gersh BJ, Bailey KR, Seward JB. Left atrial volume as a morphophysiologic expression of left ventricular diastolic dysfunction and relation to cardiovascular risk burden. Am J Cardiol. 2002. 90:1284–1289.

23. Wang K, Ho SY, Gibson DG, Anderson RH. Architecture of atrial musculature in humans. Br Heart J. 1995. 73:559–565.

24. Hatle L, Sutherland GR. Regional myocardial function--a new approach. Eur Heart J. 2000. 21:1337–1357.

25. Cho KI, Lee SH, Jang SH, Lee DW, Lee HG, Kim TI. Assessment of left atrial function and remodeling in patients with atrial fibrillation by performing strain echocardiography: a prospective study to assess the influence of renin-angiotensin system inhibitors on atrial fibrillation. Korean Circ J. 2008. 38:305–312.

26. Hoit BD, Shao Y, Gabel M, Walsh RA. Left atrial mechanical and biochemical adaptation to pacing induced heart failure. Cardiovasc Res. 1995. 29:469–474.