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Left ventricular function during and after right ventricular pacing.

Maher Nahlawi1, Michael Waligora, Stewart M Spies

  • 1Division of Cardiology, Department of Medicine, Northwestern University, Chicago, Illinois, USA.

Journal of the American College of Cardiology
|November 3, 2004
PubMed
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Right ventricular pacing significantly reduces left ventricular ejection fraction (EF) over time. This decline in EF is not solely due to altered activation sequences and persists even after pacing stops, indicating potential adverse effects.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Function

Background:

  • Right ventricular pacing disrupts normal heart rhythm and can decrease left ventricular ejection fraction (EF).
  • The extent to which altered activation sequences contribute to reduced EF is not fully understood.

Purpose of the Study:

  • To investigate the impact of right ventricular pacing on left ventricular function.
  • To determine if reduced EF is solely attributable to altered ventricular activation.

Main Methods:

  • Twelve patients with dual-chamber pacemakers and normal baseline left ventricular function were studied.
  • Left ventricular EF was measured using serial-gated blood pool imaging during atrial pacing, short-term (2 hours) and mid-term (1 week) atrioventricular (AV) sequential pacing, and after pacing cessation.

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Main Results:

  • Short-term AV pacing decreased EF from 66.5% to 60.3%.
  • Mid-term AV pacing further reduced EF to 52.9%, and EF remained depressed for at least 24 hours after pacing cessation.
  • EF recovery was incomplete even 32 hours post-pacing.

Conclusions:

  • Altered activation sequences explain only part of the EF reduction caused by right ventricular pacing.
  • Mid-term pacing leads to a greater EF reduction than short-term pacing.
  • Right ventricular pacing induces changes in ventricular function that may contribute to adverse outcomes.