scholarly journals New Onset Heart Failure after Right Ventricular Pacing in Patients with Normal Left Ventricular Function

2021 ◽  
Vol 10 (1) ◽  
pp. 365-369
Author(s):  
Fawad Qadir ◽  
Muhammad Shahid ◽  
Hadi Yousuf Saeed ◽  
Muhammad Tahir Mohyudin ◽  
Abu Bakar Ali Saad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Lv Function ◽  
Av Block ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Normal Left Ventricular ◽  
New Onset

Background: Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function. Material and Methods: This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic. Results: Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient. Conclusions: Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six months

scholarly journals Chronic Apical and Nonapical Right Ventricular Pacing in Patients with High-Grade Atrioventricular Block: Results of the Right Pace Study

2018 ◽  
Vol 2018 ◽  
pp. 1-7
Author(s):  
Carmine Muto ◽  
Valeria Calvi ◽  
Giovanni Luca Botto ◽  
Domenico Pecora ◽  
Daniele Porcelli ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Secondary Outcome ◽  
X Rays ◽  
Ventricular Pacing ◽  
Dual Chamber ◽  
Dual Chamber Pacemaker ◽  
Right Ventricular Pacing ◽  
The Right

Objective. The aim of the study was to compare the two approaches to chronic right ventricular pacing currently adopted in clinical practice: right ventricular apical (RVA) and non-RVA pacing. Background. Chronic RVA pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. Non-RVA pacing may yield more physiologic ventricular activation and provide potential long-term benefits and has recently been adopted as standard procedure at many implanting centers. Methods. The Right Pace study was a multicenter, prospective, single-blind, nonrandomized trial involving 437 patients indicated for dual-chamber pacemaker implantation with a high percentage of RV pacing. Results. RV lead-tip target location was the apex or the interventricular septum. RVA (274) and non-RVA patients (163) did not differ in baseline characteristics. During a median follow-up of 19 months (25th–75th percentiles, 13–25), 17 patients died. The rates of the primary outcome of death due to any cause or hospitalization for heart failure were comparable between the groups (log-rank test, p=0.609), as were the rates of the composite of death due to any cause, hospitalization for heart failure, or an increase in left ventricular end-systolic volume ≥ 15% as compared with the baseline evaluation (secondary outcome, p=0.703). After central adjudication of X-rays, comparison between adjudicated RVA (239 patients) and non-RVA (170 patients) confirmed the absence of difference in the rates of primary (p=0.402) and secondary (p=0.941) outcome. Conclusions. In patients with indications for dual-chamber pacemaker who require a high percentage of ventricular stimulation, RVA or non-RVA pacing resulted in comparable outcomes. This study is registered with ClinicalTrials.gov (identifier: NCT01647490).

Adverse effects of atrioventricular synchronous right ventricular pacing on left ventricular sympathetic activity, efficiency, and hemodynamic status

2006 ◽  
Vol 291 (5) ◽  
pp. H2377-H2379 ◽  
Author(s):  
Abdul Al-Hesayen ◽  
John D. Parker
Keyword(s):  
Heart Failure ◽  
Right Ventricular ◽  
Sympathetic Activity ◽  
Left Ventricular ◽  
Right Atrial ◽  
Lv Function ◽  
Atrial Pacing ◽  
Ventricular Pacing ◽  
Rv Pacing ◽  
Norepinephrine Spillover

Right ventricular (RV) pacing is now recognized to play a role in the development of heart failure in patients with and without underlying left ventricular (LV) dysfunction. We used the cardiac norepinephrine spillover method to test the hypothesis that RV pacing is associated with cardiac sympathetic activation. We studied 8 patients with normal LV function using temporary right atrial and ventricular pacing wires. All measurements were carried out during a fixed atrial pacing rate. The radiotracer norepinephrine spillover technique was employed to measure total body and cardiac sympathetic activity while changes in LV performance were evaluated with a high-fidelity manometer catheter. Atrioventricular synchronous RV pacing, compared with atrial pacing alone, was associated with a 65% increase in cardiac norepinephrine spillover, an increase in LV end-diastolic pressure, and a reduction in myocardial efficiency. These responses may play a role in the development of heart failure and poor outcomes that are associated with chronic RV pacing.

scholarly journals Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart block?

2021 ◽  
Author(s):  
Ch Bharat Siddharth ◽  
Jay Relan
Keyword(s):  
Right Ventricular ◽  
Heart Block ◽  
Complete Heart Block ◽  
Left Ventricular ◽  
Lv Function ◽  
Ventricular Pacing ◽  
Cross Sectional ◽  
Right Ventricular Pacing ◽  
Rv Pacing

Summary A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was ‘Is left ventricular superior to right ventricular pacing in children with congenital or postoperative complete heart block?’ Altogether, 19 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Two large multicentric showed that site of pacing was the major determinant of left ventricular (LV) function with LV pacing being superior to RV pacing, though the number of patients paced via LV was lesser in comparison to right ventricular (RV). There were 2 prospective, 2 retrospective and 1 cross-sectional studies with fewer patients that demonstrated superiority of LV over RV pacing in preserving LV function. Only 1 small-scale retrospective study showed similar results of LV and RV pacing on LV function. One cross-sectional study showed superiority of LV apical pacing on exercise tolerance. As per the existing literature, LV apex seems to be the most optimal site for epicardial pacing while RV free wall pacing has the highest risk of causing LV dysfunction over the long term. We conclude that LV pacing appears to be superior to RV pacing in terms of long-term effect on cardiac function and ventricular synchrony.

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