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Ventricular Dyssynchrony based on echocardiographic variables and exercise tolerance After right ventricular pacing: Impact of alternative septal lead locations
Author(s) -
Mahfouz Ragab A,
Mesbah Mohamed,
Ammar Ahmad S,
Khedr Mohammed H,
Abdullah Radwa M
Publication year - 2020
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14585
Subject(s) - medicine , cardiology , lead (geology) , ventricular dyssynchrony , ventricular pacing , speckle tracking echocardiography , cardiac resynchronization therapy , heart failure , ejection fraction , geomorphology , geology
Abstract Objective We investigated the impact of alternative locations of right ventricular (RV) pacing on l eft v entricular f unction a nd 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.