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[Left ventricular dyssynchrony in prolonged septal stimulation].

Federico Ferrando-Castagnetto1, Roberto Ricca-Mallada2, Alejandro Vidal3

  • 11Departamento de Cardiología, Centro Cardiovascular Universitario, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay,

Medicina
|October 11, 2016
PubMed
Summary

Prolonged pacemaker use can cause severe cardiac events. This study shows septal right ventricular pacing leads to significant left ventricular mechanical dyssynchrony, especially in patients with heart disease.

Keywords:
dyssynchronymyocardial infarctpacemaker

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Area of Science:

  • Cardiology
  • Nuclear Medicine
  • Biomedical Engineering

Background:

  • Pacemaker stimulation, particularly septal right ventricular pacing, is linked to severe cardiac events.
  • Evaluating left ventricular mechanical dyssynchrony (LVMD) is crucial for understanding pacemaker-induced cardiac dysfunction.

Observation:

  • Six patients with pacemakers (≥1 year) for advanced atrioventricular block underwent 99mTc-MIBI gated-SPECT and phase analysis.
  • V-Sync software measured phase bandwidth (PBW) and standard deviation (PSD) of the rest phase histogram.
  • Clinical data, pacing parameters, cardiac dimensions, scar/ischemia extent, and LVEF were analyzed.

Findings:

  • Prolonged septal pacing induced significant LVMD, even with preserved systolic function.
  • More severe dyssynchrony (higher PBW and PSD) correlated with impaired LVEF, larger left ventricle diameters, and extensive myocardial scar or ischemia.
  • PBW: 177.3° vs. 88.3°; PSD: 53.1° vs. 33.8° in patients with impaired vs. preserved LVEF, respectively.

Implications:

  • Gated-SPECT phase analysis is a valuable tool for assessing LVMD in pacemaker patients with ischemic heart disease.
  • This technique can help identify patients who may benefit from upgrading to biventricular pacing.
  • Early detection and management of LVMD can potentially mitigate severe cardiac events associated with pacemakers.