Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing
OBJECTIVES The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites. BACKGROUND 1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing...
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| Veröffentlicht in: | Journal of the American College of Cardiology 1999-02, Vol.33 (2), p.317-323 |
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| creator | Schwaab, Bernhard Fröhlig, Gerd Alexander, Christof Kindermann, Michael Hellwig, Nicola Schwerdt, Holger Kirsch, Carl-Martin Schieffer, Hermann |
| description | OBJECTIVES
The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.
BACKGROUND
1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.
METHODS
Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference (Δ) in QRS duration between apical and septal stimulation (Δxyz) was correlated with the difference in phase distribution (ΔAuC) and ejection parameters (ΔEF, ΔEC).
RESULTS
QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (Δxyz) and phase distribution (ΔAuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (ΔEF: r = 0.70931, p = 0.004; ΔEC: r = 0.74368, p = 0.002).
CONCLUSIONS
In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests. |
| doi_str_mv | 10.1016/S0735-1097(98)00562-2 |
| format | Article |
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The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.
BACKGROUND
1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.
METHODS
Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference (Δ) in QRS duration between apical and septal stimulation (Δxyz) was correlated with the difference in phase distribution (ΔAuC) and ejection parameters (ΔEF, ΔEC).
RESULTS
QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (Δxyz) and phase distribution (ΔAuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (ΔEF: r = 0.70931, p = 0.004; ΔEC: r = 0.74368, p = 0.002).
CONCLUSIONS
In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests.</description><identifier>ISSN: 0735-1097</identifier><identifier>EISSN: 1558-3597</identifier><identifier>DOI: 10.1016/S0735-1097(98)00562-2</identifier><identifier>PMID: 9973009</identifier><identifier>CODEN: JACCDI</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Aged, 80 and over ; Biological and medical sciences ; Cardiac Output ; Cardiac Pacing, Artificial - methods ; Diseases of the cardiovascular system ; Electrocardiography ; Feasibility Studies ; Female ; Follow-Up Studies ; Heart Atria - physiopathology ; Heart Block - diagnosis ; Heart Block - physiopathology ; Heart Block - therapy ; Heart Rate ; Heart Ventricles - diagnostic imaging ; Heart Ventricles - physiopathology ; Humans ; Male ; Medical sciences ; Middle Aged ; Myocardial Contraction ; Prospective Studies ; Radionuclide Ventriculography ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) ; Treatment Outcome ; Ventricular Function, Left</subject><ispartof>Journal of the American College of Cardiology, 1999-02, Vol.33 (2), p.317-323</ispartof><rights>1999 American College of Cardiology</rights><rights>1999 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c489t-2c31fbe91ff2d94cbbce78c6b418dadc15882c12704bbb964ff2255a530122a63</citedby><cites>FETCH-LOGICAL-c489t-2c31fbe91ff2d94cbbce78c6b418dadc15882c12704bbb964ff2255a530122a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0735109798005622$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1664780$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9973009$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schwaab, Bernhard</creatorcontrib><creatorcontrib>Fröhlig, Gerd</creatorcontrib><creatorcontrib>Alexander, Christof</creatorcontrib><creatorcontrib>Kindermann, Michael</creatorcontrib><creatorcontrib>Hellwig, Nicola</creatorcontrib><creatorcontrib>Schwerdt, Holger</creatorcontrib><creatorcontrib>Kirsch, Carl-Martin</creatorcontrib><creatorcontrib>Schieffer, Hermann</creatorcontrib><title>Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing</title><title>Journal of the American College of Cardiology</title><addtitle>J Am Coll Cardiol</addtitle><description>OBJECTIVES
The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.
BACKGROUND
1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.
METHODS
Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference (Δ) in QRS duration between apical and septal stimulation (Δxyz) was correlated with the difference in phase distribution (ΔAuC) and ejection parameters (ΔEF, ΔEC).
RESULTS
QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (Δxyz) and phase distribution (ΔAuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (ΔEF: r = 0.70931, p = 0.004; ΔEC: r = 0.74368, p = 0.002).
CONCLUSIONS
In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Cardiac Output</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Diseases of the cardiovascular system</subject><subject>Electrocardiography</subject><subject>Feasibility Studies</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Heart Atria - physiopathology</subject><subject>Heart Block - diagnosis</subject><subject>Heart Block - physiopathology</subject><subject>Heart Block - therapy</subject><subject>Heart Rate</subject><subject>Heart Ventricles - diagnostic imaging</subject><subject>Heart Ventricles - physiopathology</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Myocardial Contraction</subject><subject>Prospective Studies</subject><subject>Radionuclide Ventriculography</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><issn>0735-1097</issn><issn>1558-3597</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1999</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkUtLxDAQgIMouj5-gtCDiB6qSdqkyUlk8bGw4EE9h3SaaKSbrkm74L83-2BlT54yZL558A1C5wTfEEz47SuuCpYTLKsrKa4xZpzmdA-NCGMiL5is9tFoixyh4xi_MMZcEHmIDqWsCozlCA0Tb9vBeDBZZ7PgPj77bGF8HxwMrQ5Z7N0sBb3rfBZdnyiftcbuQnbwsCKcz3T61W0Wfzx8hs53Q9xB5xqc_zhFB1a30Zxt3hP0_vjwNn7Opy9Pk_H9NIdSyD6nUBBbG0mspY0soa7BVAJ4XRLR6AYIE4ICoRUu67qWvEwcZUyzAhNKNS9O0OW67zx034OJvZq5CKZttTdpM8Ul41wWVQLZGoTQxRiMVfPgZjr8KILVUrda6VZLl0oKtdKtaKo73wwY6plptlUbvyl_scnrCLq1QXtw8a8552UlcMLu1phJMhbOBBXBLY_SuGCgV03n_lnkF7KCn4Q</recordid><startdate>19990201</startdate><enddate>19990201</enddate><creator>Schwaab, Bernhard</creator><creator>Fröhlig, Gerd</creator><creator>Alexander, Christof</creator><creator>Kindermann, Michael</creator><creator>Hellwig, Nicola</creator><creator>Schwerdt, Holger</creator><creator>Kirsch, Carl-Martin</creator><creator>Schieffer, Hermann</creator><general>Elsevier Inc</general><general>Elsevier Science</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>19990201</creationdate><title>Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing</title><author>Schwaab, Bernhard ; Fröhlig, Gerd ; Alexander, Christof ; Kindermann, Michael ; Hellwig, Nicola ; Schwerdt, Holger ; Kirsch, Carl-Martin ; Schieffer, Hermann</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c489t-2c31fbe91ff2d94cbbce78c6b418dadc15882c12704bbb964ff2255a530122a63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1999</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Biological and medical sciences</topic><topic>Cardiac Output</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Diseases of the cardiovascular system</topic><topic>Electrocardiography</topic><topic>Feasibility Studies</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Heart Atria - physiopathology</topic><topic>Heart Block - diagnosis</topic><topic>Heart Block - physiopathology</topic><topic>Heart Block - therapy</topic><topic>Heart Rate</topic><topic>Heart Ventricles - diagnostic imaging</topic><topic>Heart Ventricles - physiopathology</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Myocardial Contraction</topic><topic>Prospective Studies</topic><topic>Radionuclide Ventriculography</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schwaab, Bernhard</creatorcontrib><creatorcontrib>Fröhlig, Gerd</creatorcontrib><creatorcontrib>Alexander, Christof</creatorcontrib><creatorcontrib>Kindermann, Michael</creatorcontrib><creatorcontrib>Hellwig, Nicola</creatorcontrib><creatorcontrib>Schwerdt, Holger</creatorcontrib><creatorcontrib>Kirsch, Carl-Martin</creatorcontrib><creatorcontrib>Schieffer, Hermann</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the American College of Cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schwaab, Bernhard</au><au>Fröhlig, Gerd</au><au>Alexander, Christof</au><au>Kindermann, Michael</au><au>Hellwig, Nicola</au><au>Schwerdt, Holger</au><au>Kirsch, Carl-Martin</au><au>Schieffer, Hermann</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing</atitle><jtitle>Journal of the American College of Cardiology</jtitle><addtitle>J Am Coll Cardiol</addtitle><date>1999-02-01</date><risdate>1999</risdate><volume>33</volume><issue>2</issue><spage>317</spage><epage>323</epage><pages>317-323</pages><issn>0735-1097</issn><eissn>1558-3597</eissn><coden>JACCDI</coden><abstract>OBJECTIVES
The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.
BACKGROUND
1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.
METHODS
Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference (Δ) in QRS duration between apical and septal stimulation (Δxyz) was correlated with the difference in phase distribution (ΔAuC) and ejection parameters (ΔEF, ΔEC).
RESULTS
QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (Δxyz) and phase distribution (ΔAuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (ΔEF: r = 0.70931, p = 0.004; ΔEC: r = 0.74368, p = 0.002).
CONCLUSIONS
In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>9973009</pmid><doi>10.1016/S0735-1097(98)00562-2</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Biological and medical sciences Cardiac Output Cardiac Pacing, Artificial - methods Diseases of the cardiovascular system Electrocardiography Feasibility Studies Female Follow-Up Studies Heart Atria - physiopathology Heart Block - diagnosis Heart Block - physiopathology Heart Block - therapy Heart Rate Heart Ventricles - diagnostic imaging Heart Ventricles - physiopathology Humans Male Medical sciences Middle Aged Myocardial Contraction Prospective Studies Radionuclide Ventriculography Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) Treatment Outcome Ventricular Function, Left |
| title | Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing |
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