The factors influencing ventricular dyssynchrony in patients with permanent pacemaker

Kim, Sung Soo; Cho, Jeong Gwan; Kim, Hyun Kuk; Jang, Soo Young; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Hong, Young Joon; Park, Hyung Wook; Kim, Ju Han; Ahn, Young Keun; Jeong, Myung Ho; Park, Jong Chun; Kang, Jung Chaee

Abstract

BACKGROUND/AIMS: Chronic right ventricular pacing (RVP) can lead to increased risks of ventricular dyssynchrony (VD), heart failure, and mortality. This study examined the factors influencing VD in patients treated with a permanent pacemaker (PPM).
METHODS
The study enrolled 139 patients (M:F=1:1.35, 66.8+/-1.0 years) who had permanent pacemaker implanted [AAI (R): 11, VVI (R): 39, VDD (R): 50, DDD: 39]. Their clinical characteristics, 12-lead electrocardiogram (ECG), echocardiography, and laboratory parameters were evaluated. The patients were divided into two groups according to the presence of VD.
RESULTS
VD was seen in 71.9% of the patients with a PPM. No significant difference was observed in the clinical characteristics, except for the indications and current action mode of the PPM. VD was more frequently associated with patients with AV block and ventricular pacing. The QRS duration and QTc interval were significantly wider in patients with VD (159.9+/-3.2 vs. 129.4+/-6.3 ms, p<0.001; 487.7+/-4.0 vs. 470.9+/-8.0 ms, p<0.05, respectively). On echocardiography, tricuspid regurgitation was more common in patients with VD. The N-terminal B-type natriuretic peptide (NT-proBNP) level was higher in the dyssynchrony group (431.4+/-66.1 vs. 202.8+/-40.8, p<0.05).
CONCLUSIONS
Patients with AV block and ventricular pacing developed VD more frequently. A higher serum NT-proBNP level and prolonged QRS duration, QTc, and tricuspid regurgitation might be associated with VD.