Key result
A high right ventricular pacing burden (≥40%) did not significantly alter echocardiographic parameters or clinical exercise capacity over 12 to 24 months in pacemaker patients with preserved left ventricular ejection fraction.
Why the study?
The cause of worsened clinical outcomes due to a high RV pacing burden remained unclear.
Does high RV pacing burden (≥ 40%) worsen echocardiographic and spiroergometric parameters in pacemaker patients with preserved LVEF compared to low RV pacing burden (< 40%)?
Cohort (n=108)
No
Does high RV pacing burden (≥ 40%) worsen echocardiographic and spiroergometric parameters in pacemaker patients with preserved LVEF compared to low RV pacing burden (< 40%)?
p-value: p=>0.05
May not warrant RV pacing minimization in preserved LVEF; leaves open randomized confirmation on clinical outcomes.
Background: The cause of worsened clinical outcome due to high RV pacing burden remains unclear. Objective: To investigate the impact of RV pacing on several echocardiographic and spiroergometric parameter Methods: In 60 pacemaker patients with preserved LVEF serial echocardiographies and spiroergometries were performed over a time course of 12 months. Additionally in 50 patients retrospective echocardiographic analyses of the LV- and RV function were carried out up to 24 months after pacemaker implantation. Results: The patients were divided into two groups: The high RV pacing burden group (hRVP: ≥ 40%) and the low RV pacing group (lRVP <40%) according to the definitions in previous randomized MOST and DAVID trials. After a period of 12 month pacemaker therapy there could not revealed any changes LVEDD, LVESD, LVEF, E/A-ratio; E/E’-ratio and TAPSE independently of the RV pacing burden. Additionally, after 24 month long term follow-up there were no changes in LVEF and TAPSE in both groups. Accordingly to these echo data no relevant changes of peak exercise capacity, ventilatory anaerobic threshold and maximal oxygen consumption could be revealed independently of the RV pacing. Conclusions: In pacemaker patients with preserved LVEF the burden of RV pacing has no adverse influence, neither to several echocardiographic parameters nor to the clinical exercise capacity after a follow-up of 12 to 24 month. Therefore, the mechanism of the worsened clinical outcome due to high RV pacing burden in patients without a relevant structural heart disease remains unclear.
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Youssef et al. (2021) conducted a cohort in Pacemaker indication with preserved LVEF (n=108). High right ventricular (RV) pacing burden (≥40%) vs. Low RV pacing burden (<40%) was evaluated on Changes in left and right ventricular echocardiographic parameters (LVEDD, LVESD, LVEF, E/A-ratio, E/E'-ratio, TAPSE) (p=>0.05). A high right ventricular pacing burden (≥40%) did not significantly alter echocardiographic parameters or clinical exercise capacity over 12 to 24 months in pacemaker patients with preserved left ventricular ejection fraction.
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