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[Asynchronism and right ventricular pacing].

J B Thambo1, P Bordachar, S Lafitte

  • 1Hôpital cardiologique du Haut-Lévêque, service des maladies cardiovasculaires congénitales de l'enfant et de l'adulte, Pessac. jean-benoit.thambo@chu-bordeaux.fr

Archives Des Maladies Du Coeur Et Des Vaisseaux
|June 22, 2005
PubMed
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Dual-chamber pacing improves heart rate and cardiac output in congenital heart block (CHB) patients. However, apical pacing may cause detrimental ventricular dyssynchrony, suggesting alternative pacing sites are needed.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Congenital heart block (CHB) necessitates dual-chamber pacing for physiological heart rate and atrio-ventricular synchronization.
  • Permanent apical ventricular pacing may negatively impact CHB patients with narrow QRS junctional escape rhythm.

Purpose of the Study:

  • To assess the impact of apical ventricular pacing on echocardiographic ventricular dyssynchrony and hemodynamic parameters in CHB patients.

Main Methods:

  • Fourteen CHB adults with DDD pacemakers and junctional escape rhythm (QRS<120 ms) were studied.
  • Echocardiography with tissue Doppler imaging (TDI) and Strain rate was performed during spontaneous rhythm (VVI) and atrio-synchronized ventricular pacing.

Main Results:

Related Experiment Videos

  • Atrio-ventricular synchronized apical pacing significantly increased heart rate, cardiac output, and left ventricular filling time compared to spontaneous rhythm.
  • Apical pacing resulted in significantly greater interventricular and intra-left ventricular dyssynchrony, and delayed longitudinal contraction compared to spontaneous rhythm.

Conclusions:

  • While DDD pacing enhances cardiac output in CHB patients, apical pacing is suboptimal due to induced ventricular dyssynchrony.
  • Alternative pacing sites should be explored to mitigate adverse effects in CHB patients with narrow QRS.