Right Ventricular Septal Pacing Preserves Global Left Ventricular Longitudinal Function in Comparison With Apical Pacing – Analysis of Speckle Tracking Echocardiography –

Katsuji Inoue; Hideki Okayama; Kazuhisa Nishimura; Makoto Saito; Toyofumi Yoshii; Go Hiasa; Takumi Sumimoto; Shinji Inaba; Jun Suzuki; Akiyoshi Ogimoto; Jun-ichi Funada; Jitsuo Higaki

doi:10.1253/circj.CJ-10-1138

Arrhythmia/Electrophysiology

Right Ventricular Septal Pacing Preserves Global Left Ventricular Longitudinal Function in Comparison With Apical Pacing

– Analysis of Speckle Tracking Echocardiography –

Katsuji Inoue, Hideki Okayama, Kazuhisa Nishimura, Makoto Saito, Toyofumi Yoshii, Go Hiasa, Takumi Sumimoto, Shinji Inaba, Jun Suzuki, Akiyoshi Ogimoto, Jun-ichi Funada, Jitsuo Higaki

Author information

Katsuji Inoue
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
Hideki Okayama
Department of Cardiology, Ehime Prefectural Central Hospital
Kazuhisa Nishimura
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
Makoto Saito
Department of Cardiology, Kitaishikai Hospital
Toyofumi Yoshii
Department of Cardiology, Kitaishikai Hospital
Go Hiasa
Department of Cardiology, Kitaishikai Hospital
Takumi Sumimoto
Department of Cardiology, Kitaishikai Hospital
Shinji Inaba
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
Jun Suzuki
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
Akiyoshi Ogimoto
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
Jun-ichi Funada
Department of Cardiology, Ehime National Hospital
Jitsuo Higaki
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine

Keywords: Dyssynchrony, Global longitudinal strain, Pacing, Speckle tracking echocardiography

JOURNAL FREE ACCESS

2011 Volume 75 Issue 7 Pages 1609-1615

DOI https://doi.org/10.1253/circj.CJ-10-1138

View "Advance Publication" version (May 20, 2011).

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Abstract

Background: Right ventricular (RV) pacing alters left ventricular (LV) mechanical activation, resulting in adverse impacts on LV function. This study was aimed to investigate the acute effect of RV apical (RVA) and septal pacing (RVS) on LV dyssynchrony and function using speckle tracking echocardiography. Methods and Results: The 103 patients (749 years) with symptomatic bradyarrhythmia and preserved LV ejection fraction, and 50 age-matched control subjects were studied. All patients received a permanent pacemaker and were randomly assigned into 2 groups (RVA: n=51, RVS: n=52). After insertion, patients underwent an echocardiographic study during RV pacing. LV dyssynchrony and global strain parameters were analyzed using speckle tracking echocardiography. The QRS width and dyssynchrony indices by longitudinal and radial strain were significantly greater in RVA than in both the control and RVS. The LV longitudinal dyssynchrony index was significantly related to global longitudinal strain (GLS) among 103 patients receiving RV pacing (R²=0.25, P<0.0001). The GLS in RVA were the lowest among the 3 groups (GLS: Control: -18.22.4%, RVA: -14.33.1%, P<0.001 vs. control, RVS: -16.82.7%, P<0.01 vs. RVA). Conclusions: RVA created heterogeneous LV contraction, which resulted in deteriorated LV longitudinal contraction. RVS could be a better pacing alternative in terms of less LV dyssynchrony and better longitudinal function compared to RVA. (Circ J 2011; 75: 1609-1615)

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