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- Title
Ventricular Dyssynchrony based on echocardiographic variables and exercise tolerance After right ventricular pacing: Impact of alternative septal lead locations.
- Authors
Mahfouz, Ragab A; Mesbah, Mohamed; Ammar, Ahmad S; Khedr, Mohammed H; Abdullah, Radwa M
- Abstract
Objective: We investigated the impact of alternative locations of right ventricular (RV) pacing on left ventricular function and its relation to exercise capacity. Methods: Fifty patients who received a single lead pacemaker were divided according to RV pacing site into group 1 "high septum" (n = 15), group 2 "mid‐septum" (n = 25), and group 3 "low septum" (n = 10) using a documented fluoroscopic method. Dyssynchrony parameters were obtained using different echocardiographic parameters. Their exercise tolerance was evaluated after 6 months of pacemaker implantation using 6 minutes walk test (6 MWT). Results: We found a lesser degree of dyssynchrony in mid‐location and high location compared with low location pacing (radial dyssynchrony: P <.001; maximum temporal difference: P <.01; inter‐ventricular mechanical delay: P <.05, standard deviation of time‐to‐peak strain by tissue Doppler: P <.05). Sm was significantly increased 6 months following pacemaker implantation in group 1 and group 2 in contrast to group 3 patients (P <.05). Importantly, E/e' increased significantly (P <.001) in patients with low septal location pacing. Furthermore, 6 MWT distance was significantly improved (P <.001) in favor of groups 1 and 2. Importantly, the intra‐ventricular dyssynchrony with speckle tracking was considerably less in group 1 and 2 patients. Tps‐SL ≤ 120 ms was the optimal value to predict improvement in functional capacity following high to mid‐septal pacing locations. Conclusion: There was significant improvement of functional capacity after RV pacing in high and mid‐septal locations compared with low septal location. This was associated with a lesser degree of dyssynchrony in favor with mid‐ to high septal location.
- Subjects
CARDIAC pacing; DOPPLER echocardiography; ECHOCARDIOGRAPHY; ELECTRODES; LEFT heart ventricle; RIGHT heart ventricle; HEART septum; ARTIFICIAL implants; POSTOPERATIVE period; WALKING; EXERCISE tolerance
- Publication
Echocardiography, 2020, Vol 37, Issue 2, p310
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.14585