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Evaluating the left ventricular hemodynamic phenomena of DDD septum pacemaker implants using vector flow mapping.

Qingguo Meng1, Sijia Wang1, Sijing Yan2

  • 1Key Laboratory of Ultrasound in Cardiac Electrophysiology and Biomechanics of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China.

Echocardiography (Mount Kisco, N.Y.)
|December 25, 2019
PubMed
Summary

Right ventricular double-chamber pacing increases left ventricular energy loss and decreases wall shear stress. This indicates abnormal left ventricular hemodynamics and reduced systolic efficiency after pacemaker implantation.

Keywords:
circulationenergy lossright ventricle double-chamber pacemakervector flow mapwall shear stress

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Area of Science:

  • Cardiovascular Physiology
  • Medical Device Technology
  • Hemodynamics

Background:

  • Right ventricular double-chamber pacing is a common treatment for bradycardia.
  • The impact of this pacing on left ventricular hemodynamics requires further investigation.
  • Vector flow mapping (VFM) offers a novel approach to assess intracardiac blood flow dynamics.

Purpose of the Study:

  • To assess left ventricular hemodynamic status in patients with right ventricular double-chamber pacing using VFM.
  • To evaluate energy loss (EL), wall shear stress (WSS), and circulation intensity (CIR).
  • To determine the value of VFM in measuring cardiac function post-pacemaker implantation.

Main Methods:

  • Compared 58 patients with right ventricular double-chamber pacemakers to 58 age- and gender-matched healthy controls.
  • Utilized VFM to measure left ventricular EL, vortex characteristics, and WSS across cardiac cycle phases.
  • Analyzed data including atrial contraction (AC), isovolumetric contraction (IVC), rapid filling (RF), and rapid ejection (RE).

Main Results:

  • Patients with pacemakers showed significantly higher left ventricular EL during AC, IVC, and RE phases compared to controls.
  • Left ventricular WSS was significantly lower in pacemaker patients during RF, AC, IVC, and RE phases.
  • VFM revealed significant alterations in left ventricular flow patterns due to pacing.

Conclusions:

  • Right ventricular double-chamber pacing leads to increased left ventricular EL and decreased WSS.
  • These hemodynamic changes suggest an abnormal left ventricular flow state and reduced systolic efficiency.
  • VFM is a valuable tool for assessing cardiac function and hemodynamic alterations after pacemaker implantation.