Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2014, 158(4):569-576 | DOI: 10.5507/bp.2013.009

Acute effects of right ventricular pacing on cardiac haemodynamics and transvalvular impedance

Milos Taborskya, Marian Fedorcoa, Tomas Skalaa, Eva Kocianovaa, Dalibor Pastuchab, David Richtera, Jana Petrkovaa, Franco Di Gregorioc, Alberto Barbettac, Jan Vaclavika
a Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Czech Republic
b Department of Exercise Medicine and Cardiovascular Rehabilitation, University Hospital Olomouc
c Clinical Research Unit, Medico Spa, Rubano (PD), Italy

Aims: To assess the acute side-effects of right ventricular (RV) stimulation applied in apex and mid-septum, in order to establish the optimal lead location in clinical practice.

Methods: During pacemaker implantation, the ventricular lead was temporarily fixed in the apex and then moved to mid-septum. In both positions, surface and endocardial electrograms and transvalvular impedance (32 cases), left ventricular (LV) pressure (23), and transthoracic echocardiography (10) were acquired with intrinsic activity and VDD pacing.

Results: A larger increase in QRS duration was noticed with apical than septal pacing (65 ± 25 vs. 45 ± 29 ms; P<10-4). The proportion of cases where RV stimulation affected the transvalvular impedance waveform was higher with apical lead location (56% vs. 20%; P<0.02). VDD pacing at either site reduced the maximum dP/dt by 6% with respect to intrinsic AV conduction (IAVC; P<0.005). The maximum pressure drop taking place in 100 ms was reduced by 6 and 8%, respectively, with apical and septal pacing (P<0.01 vs. IAVC). Apical VDD decreased mitral annulus velocity in early diastole (E') from 7.5 ± 1.4 to 5.9 ± 0.9 cm/s (P<0.02) and prolonged the E-wave deceleration time (DT) from 156 ± 33 to 199 ± 54 ms (P<0.02), while septal pacing induced non-significant modifications in E' and DT.

Conclusion: Ventricular stimulation acutely impairs LV systolic and diastolic performance, independent of the pacing site. Septal lead location preserves RV contraction mechanics and reduces the electrical interventricular delay.

Keywords: apical pacing, septal pacing, QRS duration, LV pressure, transvalvular impedance, echocardiography

Received: September 7, 2012; Accepted: January 29, 2013; Prepublished online: February 18, 2013; Published: December 9, 2014  Show citation

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Taborsky, M., Fedorco, M., Skala, T., Kocianova, E., Pastucha, D., Richter, D., ... Vaclavik, J. (2014). Acute effects of right ventricular pacing on cardiac haemodynamics and transvalvular impedance. Biomedical papers, 158(4), 569-576. doi: 10.5507/bp.2013.009
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