PT Journal
AU Taborsky, M
   Fedorco, M
   Skala, T
   Kocianova, E
   Pastucha, D
   Richter, D
   Petrkova, J
   Di Gregorio, F
   Barbetta, A
   Vaclavik, J
TI Acute effects of right ventricular pacing on cardiac haemodynamics and transvalvular impedance
SO Biomedical papers
PY 2014
BP 569
EP 576
VL 158
IS 4
DI 10.5507/bp.2013.009
DE apical pacing; septal pacing; QRS duration; LV pressure; transvalvular impedance; echocardiography
AB 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&lt;10<sup>-4</sup>). The proportion of cases where RV stimulation affected the transvalvular impedance waveform was higher with apical lead location (56% vs. 20%; P&lt;0.02). VDD pacing at either site reduced the maximum dP/dt by 6% with respect to intrinsic AV conduction (IAVC; P&lt;0.005). The maximum pressure drop taking place in 100 ms was reduced by 6 and 8%, respectively, with apical and septal pacing (P&lt;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&lt;0.02) and prolonged the E-wave deceleration time (DT) from 156 ± 33 to 199 ± 54 ms (P&lt;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.
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