Abstract 15108: Right Ventricular Septal Pacing Preserves Global Left Ventricular Longitudinal Function in Comparison With Apical Pacing: Analysis of Speckle Tracking Echocardiography
Background: RV pacing alters left ventricular (LV) mechanical activation pattern, Resultsing to the adverse impacts on LV function. The global longitudinal strain (GLS) by speckle tracking echocardiography (STE) is reported at a robust predictor of future cardiac events over standard LV ejection fraction and wall motion scoring. Objectives: The objective of this study was to investigate the acute effect of right ventricular apical (RVA) and septal pacing (RVS) on LV global function using STE.
Methods: 103 patients (74 ± 9 years) with symptomatic bradyarrhythmia and preserved LV ejection fraction and 50 age-matched control subjects were studied. Site of pacemaker insertion was randomly assigned into two groups in participant patients (RVA: n= 51, RVS: n=52). After insertion, patients underwent echocardiographic study during RV pacing. LV global strain parameters were analyzed using STE.
Results: The QRS width and LV dyssynchrony indices derived by longitudinal and radial strain were significantly greater in RVA than both the control and RVS. The LV longitudinal dyssynchrony index was significantly related to GLS among patients receiving RVA (R2= 0.26, P= 0.0001). The GLS and systolic global longitudinal strain rate (sGLSr) in RVA were the lowest among the 3 groups (GLS: Control: -18.2 ± 2.4%, RVA: -14.3 ± 3.1%, P< 0.001 vs control, RVS: -16.8 ± 2.7% vs RVA, P< 0.01; sGLSr: Control: -1.0 ± 0.1 s-1, RVA: -0.8 ± 0.2 s-1, P< 0.001 vs control, RVS: -0.9 ± 0.2 s-1 vs RVA, P< 0.001). In addition, the early diastolic GLSr was significantly reduced in RVA compared to control group (Control: 0.9 ± 0.3 s-1, RVA: 0.8 ± 0.3 s-1, P< 0.05 vs control, RVS: 0.9 ± 0.3 s-1).
Conclusion: RVA could reduce LV systolic global longitudinal function in parallel with LV dyssynchrony compared to RVS. RVS could be a better pacing alternative in terms of a less LV dyssynchrony and better global longitudinal function compared to RVA.
- © 2010 by American Heart Association, Inc.