Key result
RVP at peak heart rates does not change mean systolic asynchrony compared to basal rates.
Why the study?
Although right ventricular apical pacing has known detrimental effects on left ventricular function, dynamic alterations in systolic and diastolic asynchrony parameters across different paced heart rates remained to be evaluated.
Does right ventricular apical pacing at different heart rates alter systolic and diastolic asynchrony parameters in patients with permanent pacemakers?
Observational (n=23)
Does right ventricular apical pacing at different heart rates alter systolic and diastolic asynchrony parameters in patients with permanent pacemakers?
Right ventricular apical pacing frequently induces systolic and diastolic asynchrony independent of ejection fraction, with significant individual variability at different heart rates, suggesting the utility of routine tissue Doppler evaluation in this population.
Answers are grounded in this paper and cite their sources.
Significant individual variability in RV apical pacing asynchrony cautions against uniform rate-based management; leaves open optimal Doppler assessment strategies.
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.
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Türkyılmaz et al. (2021) conducted an observational in Permanent pacemaker (n=23). Right ventricular apical pacing at peak heart rate vs. Right ventricular apical pacing at basal heart rate was evaluated on Systolic asynchrony measured by standard deviation of time to peak systolic velocity (TsSD) (p=0.468). Right ventricular apical pacing at peak heart rates did not significantly change mean systolic asynchrony compared to basal heart rates, despite significant individual variability.
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