Erdem Türkyilmaz1, Taylan Akgün2, Mehmet Mustafa Can3, İbrahi̇m Hali̇l Tanboğa4, Can Yücel Karabay5, Ci̇hangi̇r Kaymaz6

1Department of Cardiology, Usak Training and Research Hospital, Usak, Turkey
2Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
3Department of Cardiology, Haseki Training and Research Hospital, Istanbul, Turkey
4Department of Cardiology, Nisantasi University and Hisar Intercontinental Hospital, Istanbul, Turkey
5Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
6Department of Cardiology, Kartal Kosuyolu High Specialization Training and Research Hospital, Istanbul, Turkey

Keywords: Asynchrony; pacemaker; tissue doppler


Introduction: The detrimental effects of right ventricular apical pacing on left ventricular function has been demonstrated by several studies. In this study we aimed to evaluate the dynamic alterations in systolic and diastolic asynchrony 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 frequency was 61% and 56% by TsSD and SLD respectively. Frequency of diastolic asynchrony was 44% by TeSD. EF was not associated with asynchrony parameters. There was positive correlation between pacemaker age and systolic asynchrony. 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 heart rate, respectively.
Conclusion: In our study systolic asynchrony and diastolic asynchrony 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 pacemaker 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.

Ethics Committee Approval

This study was approved by Kartal Kosuyolu High Specialization Training and Research Hospital Ethics Committee (2020-14-417, Date: 10.11.2020).

Peer Review

Externally peer-reviewed.

Author Contributions

Concept/Design - ET, TA, CK; Analysis/ Interpretation - ET, TA, HT; Data Collection - ET; Writing - ET, CK, MC; Critical Revision - CK, CK, CM; Statistical Analysis - ET, HT; Overall Responsibility - ET; Final Approval - All of authors.

Conflict of Interest

The authors have no conflicts of interest to declare.

Financial Disclosure

The authors declared that this study has received no financial support.