Korean Circ J.  2008 Nov;38(11):590-595. 10.4070/kcj.2008.38.11.590.

Similar Degree in Mechanical Left Ventricular Dyssynchrony Between Right Ventricular Outflow Tract and Right Ventricular Apical Pacing: A Strain Doppler Imaging Study

• Lee YS
• Han SW
• Kim YN
• Nam CW
• Kim HS
• Kim KS
• Rho RW

• KMID: 2225706
• DOI: http://doi.org/10.4070/kcj.2008.38.11.590

Abstract

BACKGROUND AND OBJECTIVES
Long-term right ventricular (RV) apex pacing has been associated with left ventricular (LV) systolic dysfunction. However, pacing in the RV outflow tract (RVOT) is associated with a narrower QRS duration and may have a more normal LV activation in comparison to RV apical (RVA) pacing. We hypothesized that RVOT pacing is associated with less mechanical dyssynchrony compared to RVA pacing and that it also more closely resembles mechanical activation in normal controls with a narrow QRS. SUBJECTS AND METHODS: We studied 9 patients with RV pacing, 9 with left bundle branch block (LBBB), and 15 normal controls with a narrow QRS. In the RV pacing group, we paced from the RVA and RVOT. At the end of each pacing train, we obtained echocardiographic images in the apical 4- and 2-chamber views and obtained the following parameters: the compression/expansion crossover point (CEP) for myocardial strain and the time from QRS onset to the CEP in the strain image. The degree of dyssynchrony was evaluated using the dispersion and standard deviation of CEP times in 12 segments of the LV. RESULTS: Significant dyssynchrony was observed in the RVOT pacing group compared to the group with normal QRS. No significant difference was observed in LV mechanical dyssynchrony among the RVOT pacing, RVA pacing, and LBBB groups. CONCLUSION: RVOT pacing is associated with significant LV dyssynchrony. Although the RVOT has been recommended as an alternative site for pacing, this approach may have adverse effects on long-term LV function.

Keyword

Cardiac pacing; artificial; Right ventricle

MeSH Terms

Bundle-Branch Block
Heart Ventricles
Humans
Sprains and Strains

Figure

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  Fig. 1 Measurement of strain in twelve segments. The strain was measured at the compression/expansion crossover point (arrow), which represented the degree of actual contraction. We also defined the time from QRS onset to the compression/expansion crossover point (CEP) as the CEP time (arrow). Since this CEP time represents the actual contraction time of each segment, it could be a useful tool for analyzing dyssynchrony.

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  Fig. 2 Comparison of the QRS width in each group. RVA/RVOT: right ventricular apical and outflow tract pacing, LBBB: left bundle branch block.

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  Fig. 3 Mean strain for each group. RVA/RVOT: right ventricular apical and outflow tract pacing, LBBB: left bundle branch block.

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  Fig. 4 Mean strain in each wall. RVA/RVOT: right ventricular apical and outflow tract pacing, LBBB: left bundle branch block.

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  Fig. 5 Mean dispersion of compression/expansion crossover point (CEP) time. RVA/RVOT: right ventricular apical and outflow tract pacing, LBBB: left bundle branch block.

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  Fig. 6 Standard deviations (SD) of the mean compression/expansion crossover point (CEP) times in each group. RVA/RVOT: right ventricular apical and outflow tract pacing, LBBB: left bundle branch block.

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