The Effect of Right Ventricular Apical Pacing on Asynchrony Parameters in Different Heart Rates Detected by Tissue Doppler Imaging in Patients with Permanent Pacemaker
1Kartal Koşuyolu Yüksek İhti̇sas Eği̇ti̇m Ve Araştirma Hastanesi̇, Cardi̇ology, İstanbul, Turkey
2Uşak Eği̇ti̇m Ve Araştirma Hastanesi̇, Cardi̇ology, Uşak, Turkey
3Haseki̇ Eği̇ti̇m Ve Araştirma Hastanesi̇, Cardi̇ology, İstanbul, Turkey
4Ni̇şantaşi Üni̇versi̇tesi̇ Ve Hi̇sar İnterconti̇nental Hastanesi̇, Cardi̇ology, İstanbul, Turkey
5Başakşehi̇r Çam Ve Sakura Hastanesi̇, Cardi̇ology, İstanbul, Turkey
6Sağlik Bi̇li̇mleri̇ Üni̇versi̇tesi̇ Dr. Si̇yami̇ Ersek Göğüs Kalp Ve Damar Cerrahi̇si̇ Eği̇ti̇m Ve Araştirma Hastanesi̇, Cardi̇ology, İstanbul, Turkey
Keywords: asynchrony, pacemaker, ti̇ssue doppler
Objectives: The detrimental effects of right ventricular apical pacing (RVAP) on left ventricular (LV) function has been demonstrated by several studies. In this study we aimed to evaluate the dynamic alterations in systolic and diastolic asynchrony (SA,DA) parameters in the slowest and fastest paced rhythm.
Patients and Methods: We included 23 permanent pacemaker patients to this study. We assessed dynamic changes in asynchrony and volumetric parameters with increasing heart rates by Tissue Doppler and two dimensional imaging.
Results: In basal heart rates Systolic Asynchrony (SA) frequency was 61% and 56% by TsSD and SLD respectively. Frequency of Diastolic Asynchrony(DA) was 44% by TeSD. EF was not associated with asynchrony parameters. There was positive correlation between pacemaker age and SA.
Both TsSD and SLD values were similar at basal and peak heart rates in overall study population but there was remarkable individual variability in alterations both in directions and quantities. Correlation between TsSD and SLD was 0.99 and 0.83 at basal and peak HR, respectively.
Conclusion: In our study SA and DA was found to be very frequent independent from EF in pacemaker population. Dynamic changes with different heart rates in asynchrony parameters revealed individual variability. Routine evaluation of PM population must consist asynchrony parameters beside EF. SLD measurement is a relatively easy and accurate method for asynchrony evaluation. Evaluation of asynchrony parameters in different heart rates in symptomatic patients with normal or near normal resting echocardiographic findings can help early modification of pacing modality before systolic dysfunction development.