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Intraventricular flow patterns during right ventricular apical pacing.

Francesco Bianco^1,2, Vincenzo Cicchitti¹, Valentina Bucciarelli¹

¹Institute of Cardiology, "G. d'Annunzio" University, Chieti, Italy.

|June 7, 2019

Summary

Right ventricular apical pacing impairs blood flow momentum and increases kinetic energy dissipation, significantly reducing left ventricular global longitudinal strain. These changes may contribute to heart failure development.

Keywords:

blood flow momentum cardiac dyssynchrony heart failure intraventricular flow patterns right ventricular pacing

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Area of Science:

Cardiology
Biomedical Engineering
Hemodynamics

Background:

Cardiac dyssynchrony can arise from electrical stimulation, potentially impacting cardiac function.
Understanding the hemodynamic consequences of right ventricular apical (RVA) pacing is crucial for managing heart failure.
Left ventricular global longitudinal strain (LV GLS) is a key indicator of myocardial function.

Purpose of the Study:

To compare blood flow momentum (BFM) and kinetic energy (KE) dissipation during RVA pacing versus spontaneous sinus rhythm.
To investigate the association between hemodynamic changes and LV GLS during RVA pacing.

Main Methods:

Cross-sectional study of 12 patients recently implanted with pacemakers, with preserved ejection fraction and low pacing dependence.
Echocardiography including particle image velocimetry and left ventricular strain analysis was performed.
Hemodynamic parameters (BFM, KE dissipation) and LV GLS were measured during sinus rhythm and RVA pacing.

Main Results:

RVA pacing significantly increased BFM and KE dissipation during both diastole and systole compared to sinus rhythm.
LV GLS significantly decreased during RVA pacing.
Multivariable analysis revealed that BFM impairment and diastolic KE dissipation were significantly associated with LV GLS deterioration.

Conclusions:

RVA pacing leads to significant alterations in BFM and KE dissipation.
These hemodynamic changes are linked to impaired LV GLS.
The observed changes may promote cardiac remodeling and contribute to the progression of heart failure.