scholarly journals The effect of right ventricular pacemaker lead position on functional status in patients with preserved left ventricular ejection fraction

2016 ◽  
Vol 69 (7-8) ◽  
pp. 212-216
Author(s):  
Vladimir Mitov ◽  
Zoran Perisic ◽  
Aleksandar Jolic ◽  
Tomislav Kostic ◽  
Aleksandar Aleksic ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Lead Position ◽  
The Right

Introduction. The study was aimed at assessing the difference between the right ventricle apex versus the right ventricular outflow tract lead position in functional capacity in the patients with the preserved left ventricular ejection fraction after 12 months of pacemaker stimulation. Material and Methods. This was a prospective, randomized, follow-up study, which lasted for 12 months. The study sample included 132 consecutive patients who were implanted with permanent anti-bradicardiac pacemaker. Regarding the right ventricular lead position the patients were divided into two groups: the right ventricle apex group consisting of 61 patients with right ventricular apex lead position. The right ventricular outflow tract group included 71 patients with right ventricular outflow tract lead position. Functional capacity was assessed by Minnesota Living With Heart Failure score, New York Heart Association class and Six Minute Walk Test. Left ventricular ejection fraction was assessed by echocardiography. Results. Minnesota Living With Heart Failure score and New York Heart Association class had a statistically significant improvement in both study groups. The patients from right ventricle apex group walked 20.95% (p=0.03) more in comparison to starting values. The patients from right ventricular outflow tract group walked only 13.63% (p=0.09) longer distance than the starting one. Conclusion. Analysis of tests of functional status New York Heart Association class and Minnesota Living With Heart Failure questionnaire showed an even improvement in the right ventricle apex and right ventricular outflow tract groups. Analysis of 6 minute walk test showed that only the patients with the preserved left ventricular ejection fraction from the right ventricle apex group had a significant improvement after 12 months of pacemaker stimulation.

scholarly journals Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Bortolo Martini ◽  
Nicola Trevisi ◽  
Nicolò Martini ◽  
Li Zhang
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Diverticulum ◽  
Right Ventricular Wall ◽  
Left Ventricular Diverticulum ◽  
The Right

A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches.

scholarly journals Left bundle branch pacing: efficacy and safety compared to right ventricular outflow tract pacing

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
A Riano Ondiviela ◽  
M Cabrera Ramos ◽  
JR Ruiz Arroyo ◽  
J Ramos Maqueda
Keyword(s):  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Left Ventricular Ejection ◽  
Pacing Threshold ◽  
Ventricular Ejection Fraction ◽  
Ventricular Lead ◽  
Qrs Duration

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with preserved left ventricular ejection fraction (LVEF) and atrioventricular block (AVB) who are anticipated for high-burden of right ventricular (RV) pacing possess a risk to develop pacing-induced cardiomyopathy and adverse clinical outcomes. Left bundle branch pacing (LBBP) has recently emerged as a mode of conduction system pacing in the quest for physiological pacing. Purpose The aim of our study was to assess LBBP feasibility and safety compared to right ventricular outflow tract pacing (RVOTP). Methods Single centre randomized clinical trial to investigate acute success, feasibility and safety of LBBP versus RVOTP. May to October 2020. Patients with pacemaker indication and preserved LVEF were randomized 1:1 and followed up 3 months. Success was defined in LBBP group as a paced ECG < 120ms or with a 20% length reduction from the basal ECG. Results 120 patients were randomized, 60 in each group, 61% males. The mean age was 77,9 ± 9 years and third-degree AVB was the main pacing indication. The procedure was successful in 95% of the cases in both groups (p = 1). The paced QRS interval was narrower in the LBBP group compared to the RVOT group (99 ± 2 ms vs 113,6 ± 11,7 ms, p < 0,001). Lower fluoroscopy times were achieved in LBBP group (3.1 ± 2.1 min vs 4.3 ± 3.4, p = 0,035) and also longer procedure times in LBBP group (68,9 ± 36,9 min vs 44,3 ± 18,7 min, p < 0,001). No complications were achieved and no difference in ventricular lead dislocation was found between both groups (1.6% vs 1.6%)(p = 1). Conclusions LBBP is feasible, safe and provides a narrower paced QRS compared to RVOTP. LBBP required lower fluoroscopy times but longer procedure times compared to RVOTP. LBBP (n = 60) RVOTP (n = 60) p Age (mean ± SD) 76,7 ± 9 79,7 ± 8 0,067 Male gender 62 (37) 60 (36) 1 Successful procedure 95 (57) 95 (57) 1 Basal left bundle branch block 15 (9) 13 (8) Basal QRS duration (mean ± SD) 112,6 ± 29,6 109,9 ± 25,8 0,59 Pacing QRS duration (min)(mean ± SD) 99 ± 2 139,6 ± 11,7 < 0,001 Procedure time (min) (mean ± SD) 68,9 ± 36,9 44,3 ± 18,7 < 0,001 Fuoroscopy time (min)(mean ± SD) 3.1 ± 2.1 4.3 ± 3.4 0,035 R wave (mV)(mean ± SD) 9,9 ± 5,7 9,9 ± 5 0,98 Right ventricle pacing threshold (V)(mean ± SD) 0,67 ± 0,3 0,58 ± 0,24 0,08 Ventricular lead dislocation 1.6 (1) 1.6 (1) 1

scholarly journals 113 Echocardiographic assessment of right ventricular outflow tract obstruction in hypertrophic cardiomyopathy - efficacy of dual chamber pacing in reducing of gradient

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Wojtkowska ◽  
R Zarczuk ◽  
W Brzozowski ◽  
S Lukasik ◽  
M Tomaszewski ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Ventricular Outflow Tract Obstruction ◽  
Spectral Doppler ◽  
The Right ◽  
Av Delay

Abstract Hypertrophy of the right ventricle (RV) in the course of hypertrophic cardiomyopathy (HCM) is found in 30-60% of cases, with the possibility of a right ventricular outflow tract obstruction (RVOTO), obstruction in the apex or the middle part of the right ventricle. A patient, aged 41, admitted due to limitation of exercise tolerance, effort dyspnea, presyncope. In an echocardiogram, interventricular septum (IVS) hypertrophy was observed up to 2.0 cm; normal size of the heart cavities; normal left ventricular systolic function (EF-70%). A color doppler mapping detected the zone of flow acceleraction and turbulent flow in right ventricular outflow tract (RVOT), next a spectral doppler examination showed the RVOT obstruction with a maximal gradient of 64 mmHg. Because of the suboptimal echocardiographic imaging, a heart CT scan was performed, revealing the features of left ventricular hypertrophy, most severe at the base and the medium part of IVS (up to 25 mm). Asymmetric hypertrophy of the middle portion of the right ventricle and right ventricular outflow tract obstruction was also observed. A hemodynamic study confirmed the presence of gradient in RVOT, up to 40 mmHg. Holter electrocardiogram recorded an episode of non-sustained ventricular tachycardia. Taking into account the clinical picture, the family history of the disease, and calculated HCM Risk SCD (7.55%), the decision was made to implant a dual chamber cardioverter defibrillator. The defibrillator electrode was fixed at the apex of the right ventricle. A short AV delay was programmed for prevalent right ventricular stimulation (AV delay 100 ms), resulting in 99.6% ventricular stimulation. The control echocardiogram showed a reduction in the maximum gradient in RVOT to 24 mmHg. In addition, the patient was treated with a beta-blocker. To sum up, in the case of HCM we should always examine the RV with color and spectral doppler to exclude potential narrowing in RV. Constant AV sequential stimulation with a short AV delay is a recognized method that can be considered in symptomatic adult HCM patients with a left ventricular outflow tract obstruction. In the case described here, the above mentioned method proved effective in the significant reduction of the gradient in the right ventricular outflow tract. Abstract 113 Figure. gradient in RVOT

scholarly journals P180 Pulmonary valve stenosis and pulmonary trunk aneurysm in old female with syncope

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Fiore ◽  
A M F Ali ◽  
T Kemaloglu Oz ◽  
G Cagnazzo ◽  
M Melone ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Pulmonary Trunk ◽  
Aortic Aneurysms ◽  
Heart Team ◽  
The Right

Abstract A 77-year-old female, known hypertensive and dyslipidemic on treatment presented with three episodes of syncope in the last two months. On examination; there was grade 4/6 harsh systolic murmur on the lateral sternal border. Transthoracic echocardiography was difficult because of mesocardia and abnormal rotation of the heart due to enlarged right sided chambers. There is mild left ventricular hypertrophy with normal ejection fraction, no left sided valvular disease. The right ventricle was hypertrophied and dilated with normal RV function. The pulmonary valve was thickened with significant systolic flow aliasing through the valve with significant regurgitation and huge main pulmonary trunk aneurysm (59 mm at its wideset diameter) (Figure 1). Transthoracic approach did not allow a correct alignment of the Doppler CW and the correct estimate of pulmonary valvulopathy; TEE was performed with a correct visualization of the valve in deep transgastric projection at 90 degrees. The valve was thickened, fibrotic, degenerated with systolic doming of leaflets (Figure 2) and peak systolic gradient ∼ 70 mmHg (Figure 3). 3D reconstruction of the valve showed a tricuspid valve (Figure 4) with a valve area ∼ 0.9 cm2 using planimetry in MPR (Figure 5). CT scan was performed which confirmed the main pulmonary trunk aneurysm ∼ 60 mm (Figure 6). Therefore, in light of the clinical and instrumental picture, the patient was referred to heart team discussion for the plan of surgical intervention. Discussion According to the ESC guidelines for grown up congenital heart disease in 2010, this pulmonary valve should be intervened upon as it is severe symptomatic PS (1), but there are 2 problems with this case; the first is significant associated PR, so no place for balloon dilatation here, the second problem is the pulmonary artery aneurysm (PAA). The dilemma of management of pulmonary PAA is that all the available data are about aortic aneurysms. Indications for intervention for PAA include: Absolute PAA diameter ≥ 5.5 cm, Increase in the diameter of the aneurysm of ≥ 0.5 cm in 6 mo, Compression of adjacent structures, Thrombus formation in the aneurysm sack, Evidence of valvular pathologies or shunt flow Verification of PAH, Signs of rupture or dissection (2). Surgery could include: Aneurysmorrhaphy only decreases the diameter of the vessel (3). Aneurysmectomy and repair or replacement of the right ventricular outflow tract is commonly used technique recently and mostly suits connective tissue disorders (6). Also, Replacement of the PA and the pulmonary trunk with a conduit (Gore-Tex or Dacron tubes, homografts, or xenografts) starting in the right ventricular outflow tract with replacement of the pulmonary valve (4). Conclusion PAA management is currently challenging because there are no clear guidelines on its optimal treatment. The presence of significant pulmonary valve dysfunction could affect the decision making of the associated PAA management. Abstract P180 Figure.

scholarly journals Individualized Surgical Reconstruction of the Right Ventricle Outflow Tract in Double Outlet Right Ventricle With Mirror Image-Dextrocardia

2021 ◽  
Vol 9 ◽  
Author(s):  
Wangping Chen ◽  
Chukwuemeka Daniel Iroegbu ◽  
Xia Xie ◽  
Wenwu Zhou ◽  
Ming Wu ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Right Ventricular ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Double Outlet Right Ventricle ◽  
Mirror Image ◽  
Outflow Tract ◽  
Surgical Reconstruction ◽  
The Right

Introduction: The purpose of this study was to report our experience in the surgical reconstruction of the right ventricular outflow tract in double outlet right ventricle with a major coronary artery crossing the right ventricular outflow tract in the presence of mirror image-dextrocardia.Methods: From January 2005 to December 2019, 19 double outlet right ventricle patients (median age 4 years) with mirror image-dextrocardia and a major coronary artery crossing the right ventricular outflow tract received surgical repair. An autologous pericardial patch was used to enlarge the right ventricular outflow tract in four patients without pulmonary stenosis and three patients with mild pulmonary stenosis. A valved bovine jugular venous conduit was added to a hypoplastic native pathway in nine patients, among which six patients with moderate pulmonary stenosis received small-sized bovine jugular venous conduit implantation (diameter ≤ 16 mm). In comparison, a large-sized bovine jugular venous conduit (diameter >16 mm) was adopted in a total of three patients with severe pulmonary stenosis. Finally, three patients with preoperative pulmonary hypertension (mean pulmonary artery pressure ≥40 mmHg) did not undergo further intervention of right ventricular outflow tract due to the adequate outflow tract blood flow.Results: There was no hospital mortality. One patient with sub-pulmonary ventricular septal defect and concomitant severe pulmonary hypertension died from respiratory failure 11 months after the operation. Kaplan-Meier survival was 94% at 5, 10 years. Within a mean echocardiographic follow-up of 6.9 ± 3.6 years, a total of two patients received reintervention due to valvular stenosis of the bovine jugular venous conduit (pressure gradient > 50 mmHg at 4 and 9 years) after surgical operation. Actuarial freedom from reoperation was 90 and 72% at 5 and 10 years, respectively. During the last echocardiographic follow-up phase, all the survivors were in NYHA class I.Conclusions: Double outlet right ventricle with mirror image-dextrocardia is a rare and complicated congenital cardiac malformation. Surgical reconstruction of the right ventricular outflow tract should be individualized based on the degree of pulmonary stenosis and the specific anatomical features of each patient. Reconstructing the pulmonary artery using the various sizes of valved bovine jugular venous conduit is a safe and effective surgical method.

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