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Patients with Ebstein’s anomaly can present with bradyarrhythmias at any age. In view of the abnormal tricuspid valve anatomy associated with this condition, pacing these individuals can present with various challenges. We present a patient with Ebstein’s anomaly
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Resumen Introducción: Independientemente de la modalidad de estimulación (VVI o DDD), el mayor porcentaje de estimulación ventricular derecha deteriora la función contráctil izquierda. Por ello se han estudiado diferentes sitios de estimulación. Objetivo: Describir las diferencias electrocardiográficas y ecocardiográficas entre la estimulación en la región apical y la región septal del ventrículo derecho (VD)0. Métodos: Se estudió a 24 pacientes, 2 mujeres y 22 hombres, con fracción de eyección deprimida (≤ 35%) secundaria a estimulación en punta de VD. Se realizó electrocardiograma durante estimulación en ápex de VD y en seguimiento de estimulación septal. También ecocardiografía en ambos momentos. Resultados: La fracción de eyección se incrementó desde 31 ± 3.1% hasta 45 ± 12% (p = 0.0041) con estimulación septal; esta mostró mejor grado de sincronía mecánica. Conclusiones: La estimulación septal puede constituir un sitio de elección en pacientes con disfunción sistólica de ventrículo izquierdo secundaria a estimulación en ápex de VD, los cuales presenten QRS estrecho en su conducción intrínseca, pues en la muestra estudiada produce una mejoría en la sincronía electromecánica, demostrándose incrementos significativos en la fracción de eyección.
Abstract Introduction: Regardless of the type of electrical stimulation (VVI or DDD) the highest percentage of right ventricular apical pacing can cause left ventricular failure. For this reason, studies have been performed in different sites on right ventricle pacing. Objective: To describe differences between electrocardiography and echocardiography variables during right ventricular apical pacing and septal pacing. Methods: A total of 24 patients were studied, 2 women and 22 men, with heart failure due to conventional pacing on right ventricular (ejection fraction ≤ 35%). An electrocardiogram as well as an echocardiogram, was performed during right ventricular apical pacing and when patients were paced on septal area. Results: The ejection fraction increased from 31 ± 3.1% to 45 ± 12% (P=.0041) on septal pacing, showing higher degree of mechanic synchronisation. Conclusions: Pacing on septal area could be a good site for those patients that suffer heart failure due to right ventricular apical pacing. These must show narrow QRS on their intrinsic electrocardiographic conduction. This kind of pacing can produce an improvement in electro- mechanical synchronisation, as well as show an increased left ventricular ejection fraction.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Cardiac Pacing, Artificial/methods , Ventricular Function, Left , Ventricular Dysfunction, Left/epidemiology , Heart Failure/epidemiology , Echocardiography , Cardiac Pacing, Artificial/adverse effects , Ventricular Dysfunction, Left/etiology , Electric Stimulation , Electrocardiography , Heart Failure/etiologyABSTRACT
Objective To investigate the advantage and disadvantage of the right ventricular outflow septal pacing.Methods Eighty patients requiring pacemaker because of slow arrhythmia were randomly divided into the active fixation group and passive fixation group.The implantation time, radiation exposure time and changes of electrocardiogram were compared between 2 groups,and the heart function changes 1 year after treatment were observed by color Doppler ultrasound.Results The implantation time and radiation exposure time in active fixation group were significantly longer than those in passive fixation group: (20.00 ± 3.48) min vs.(15.00 ± 2.67) min and (9.45 ± 3.48) min vs.(6.78 ± 2.67)min,and there were statistical differences(P<0.05).The QRS duration and QTc duration in active fixation group were significantly shorter than those in passive fixation group:(0.119 2 ± 0.042 1)s vs.(0.142 3 ± 0.032 4)s and(0.403 5 ± 0.026 8)s vs.(0.442 7 ± 0.054 1)s,and there were statistical differences(P<0.05).In active fixation group,there were no statistical differences in left atrial diameter, left ventricular end-diastolic diameter, left ventricular minor axis decurtaion rate and left ventricular ejection fraction, compared before treatment and 1 year after treatment (P>0.05).Conclusions The application of the active electrode lead in the right outflow trace septal pacing is more associated with wider physiological ventricular function.
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Lead placement for ventricular pacing variably impacts the physiological benefit of the patient. This study evaluated the ventricular lead performance and safety of right ventricular outflow tract septal pacing in patients with bradyarrhythmia in South China over 60-month follow-up. Totally, 192 patients (108 males, and 84 females, 63±21 years old) with bradyarrhythmia were randomly divided into two groups. The right ventricular outflow tract septum (RVOTs) group had lead placement near the septum (n=97), while the right ventricular apex (RVA) group had a traditional apical placement (n=95). RV septal lead positioning was achieved with a specialized stylet and confirmed using fluoroscopic projection. All patients were followed up for 60 months. Follow-up assessment included stimulation threshold, R-wave sensing, lead impedance and lead complications. The time of electrode implantation in both the ROVTs and RVA groups were significantly different (4.29±0.61 vs. 2.16±0.22 min; P=0.009). No differences were identified in threshold, impedance or R-wave sensing between the two groups at 1st, 12th, 36th and 60th month during the follow-up period. No occurrence of electrode displacement, increased pacing threshold or inadequate sensing was found. The long-term active fixation ventricular electrode performance in RVOTs group was similar to that in RVA group. RVOTs pacing near the septum using active fixation electrodes may provide stability during long-term follow-up period.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Follow-Up Studies , Heart Septum , Heart Ventricles , Pacemaker, Artificial , Single-Blind MethodABSTRACT
66 patients with sick sinus syndrome were enrolled in this study. All patients meeting the indications for dual chamber pacing were randomly divided into two groups: right atrial appendage(RAA) pacing group was made up of 36 patients and low atrial septal(LAS) pacing group was made up of 30 patients. Follow-up was 12 months. The incidence of atrial fibrillation(AF) was lower in LAS group(3. 3% ) compared with the RAA group(19. 4% );P wave dispersion in RAA group was significantly higher than that in the LAS group (P < 0. 01). After 3 months of the operation, left atrial volume index(LAVI) in RAA group was significantly larger than that in the LAS group. In LAS group compared with the RAA group P wave dispersion and LAVI were significantly lower after operation in sick sinus syndrome. LAS pacing was superior to RAA pacing in preventing new atrial fibrillation.
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Objective To evaluate the short-term effect of low atrial septum pacing and different pacing frequency to prevent atrial fibrillation in patients with sick sinus syndrome . The electrophysiological mechanism would be ana-lyzed. Methods Thirty eight sick sinus syndrome patients were randomly divided to right atrial appendage pacing group and low atrial septum pacing group. The conduction time from P wave to left atrial and left atrioventricular in-terval was measured at different atrial pacing frequency. The effects of different atrial pacing frequency on interatrial conduction time were analyzed. The occurrence of atrial fibrillation was compared within an average one year follow-up period. Results ①There were no differences in basic information before treatment between the two groups. ②There were no complication, pacing and sensing dysfunction between the two groups.③The occurrence of atrial fi-brillation in low atrial septal group was lower than that in right atrial appendage pacing group. Similarly, the con-duction time from P wave to left atrial was shorter and left atrioventricular conduction time was longer in low atrial septal group. The difference was statistically significant.④ Left atrioventricular interval was longer in high pacing frequency(80 bpm) compared to low pacing frequency(60 bpm) between the two groups. The difference was statis-tically significant. Conclusion In sick sinus syndrome patients, the occurrence of atrial fibrillation is lower on low-er atrial septal group. Increasing atrial pacing percentage may be enhanced the effect. The mechanism may be asso-ciated with shortened interatrial conduction and extended left atrioventricular interval, which improves interatrial and left atrioventricular synchrony eventually.
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FUNDAMENTO: A estimulação de ventrículo direito pode ser deletéria em pacientes com disfunção ventricular, porém, em pacientes com função normal, o impacto desta estimulação desencadeando disfunção ventricular clinicamente relevante não é completamente estabelecido. OBJETIVOS: Avaliar a evolução clínica, ecocardiográfica e laboratorial de pacientes, com função ventricular esquerdapreviamente normal, submetidos a implante de marca-passo. MÉTODO: Estudo observacional transversal em que foram acompanhados de forma prospectiva 20 pacientes submetidos a implante de marca-passo com os seguintes critérios de inclusão: função ventricular esquerda normal definida pelo ecocardiograma e estimulação ventricular superior a 90%. Foram avaliados: classe funcional (CF) (New York Heart Association), teste de caminhada de 6 minutos (TC6), dosagem do hormônio natriurético tipo B (BNP), avaliação ecocardiográfica (convencional e parâmetros de dessincronismo) e questionário de qualidade de vida (QV) (SF-36). A avaliação foi feita com dez dias (t1), quatro meses (t2), oito meses (t3), 12 meses (t4) e 24 meses (t5). RESULTADOS: Os parâmetros ecocardiográficos convencionais e de dessincronismo não apresentaram variação estatística significante ao longo do tempo. O TC6, a CF e a dosagem de BNP apresentaram piora ao final dos dois anos. A QV teve melhora inicial e piora ao final dos dois anos. CONCLUSÃO: O implante de marca-passo convencional foi associado à piora da classe funcional, piora do teste de caminhada, aumento da dosagem de BNP, aumento da duração do QRS e piora em alguns domínios da QV ao final de dois anos. Não houve alterações nas medidas ecocardiográficas (convencionais e medidas de assincronia).
BACKGROUND: Right ventricular pacing may be deleterious in patients with left ventricular dysfunction, but in patients with normal function the impact of this stimulation triggering clinically relevant ventricular dysfunction is not fully established. OBJECTIVES: To evaluate the clinical, echocardiographic findings of patients with previously normal left ventricular function underwent implantation of a pacemaker. METHODS: Observational, cross-sectional study with 20 patients, who underwent implantation of pacemaker, prospectively followed-up, with the following inclusion criteria: normal left ventricular function defined by echocardiography and ventricular pacing higher than 90%. Were evaluated functional class (FC) (New York Heart Association), 6-minute walk test (6MWT), B-type natriuretic peptide (BNP), echocardiographic assessment (conventional and dyssynchrony parameters), and quality of life questionnaire (QLQ) (SF-36). The assessment was performed at ten days (t1), four months (t2), eight months (t3), 12 months (t4) and 24 months (t5). RESULTS: Conventional echocardiographic parameters and dyssynchrony parameters showed statistically significant variation over time. The 6MWT, FC, and BNP showed worsening at the end of two years. QLQ showed initial improvement and worsening at the end of two years. CONCLUSION: The implantation of conventional pacemaker was associated with worsening in functional class, worsening in walk test, increased BNP levels, increased duration of QRS, and worsening in some domains of the QLQ at the end of two years. There were no changes in echocardiography measurements (conventional and asynchrony measures).