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01-10-2013 | Original Article

Deterioration of left ventricular ejection fraction and contraction synchrony during right ventricular pacing in patients with left bundle branch block

Authors: Mati Friehling, MD, Daniel R. Ludwig, ScB, Michael Dunn, ScB, Donald Siddoway, MD, Prem Soman, MD, PhD, David Schwartzman, MD

Published in: Journal of Nuclear Cardiology | Issue 5/2013

Background

Electrocardiographic left bundle branch block (LBBB) may be intrinsic, due to ventricular conduction system disease, or induced by right ventricular pacing. Prior reports clearly delineate the derogatory impact of LBBB on left ventricular (LV) mechanical synchrony and global function, and suggest that the intrinsic and induced varieties are equivalent. This study sought to determine the difference in LV synchrony and global function between intrinsic LBBB and right ventricular apical pacing induced LBBB.

Methods

Ten patients with heart failure, diminished ejection fraction (EF) (33 ± 11%), intrinsic LBBB and an implanted cardiac pacing device were studied. In each patient, separate gated SPECT acquisitions were performed during intrinsic ventricular activation (atrial pacing) and during induced LBBB (atrial and right ventricular pacing). During each condition, LVEF, contraction synchrony (phase standard deviation, PSD), and spatial pattern of activation were measured.

Results

Compared to intrinsic, induced LBBB was associated with decreased EF (30 ± 11% vs 33 ± 11%, P = .007), contraction synchrony (PSD 49.7 ± 23.2° vs 41.6 ± 19.8, P = .02), and a disparate spatial pattern of activation.

Conclusions

Induced LBBB is associated with significantly worse global and regional LV mechanical function than intrinsic LBBB.

Tanaka H, Hara H, Adelstein EC, Schwartzman D, Saba S, Gorcsan J III. Comparative mechanical activation mapping of RV pacing to LBBB by 2D and 3D speckle tracking and association with response to resynchronization therapy. JACC Cardiovasc Imaging 2010;3:461.PubMedCrossRef

Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony. Implications for therapy. J Am Coll Cardiol 2009;54:764-76.PubMedCrossRef

Chen J, Garcia EV, Lerakis S, Henneman MM, Bax JJ, Trimble MA et al. Left ventricular mechanical dyssynchrony as assessed by phase analysis of ECG-gated SPECT myocardial perfusion imaging. Echocardiography 2008;25:1186-94.

Soneson H, Ubachs JF, Ugander M, Arheden H, Heiberg E. An improved method for automatic segmentation of the left ventricle in myocardial perfusion SPECT. J Nucl Med 2009;50:205-13.PubMedCrossRef

Cerqueira MD, Weissman NJ, Dilsizian V, Jacobs AK, Kaul S, Laskey WK, et al. Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart: A statement for healthcare professionals from the cardiac imaging committee of the council on clinical cardiology of the American Heart Association. Circulation 2002;105:539-42.PubMedCrossRef

Rodriguez L, Timmermans C, Nabar A, Beatty G, Wellens HJJ. Variable patterns of septal activation in patients with left bundle branch block and heart failure. J Cardiovasc Electrophysiol 2003;14:135-41.PubMedCrossRef

Wilkoff BL, Cook JR, Epstein AE, Greene L, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The dual chamber and VVI implantable defibrillator (DAVID) trial. J Am Med Assoc 2002;288:3115-23.CrossRef

Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932-7.PubMedCrossRef

Friehling M, Chen J, Saba S, Bazaz R, Schwartzman D, Adelstein EC, et al. A prospective Pilot study to evaluate the relationship between acute change in left ventricular synchrony after cardiac resynchronization therapy and patient outcome using a single-injection gated SPECT protocol clinical perspective. Circ Cardiovasc Imaging 2011;4:532-9.PubMedCrossRef

10.

Adelstein EC, Saba S. Scar burden by myocardial perfusion imaging predicts echocardiographic response to cardiac resynchronization therapy in ischemic cardiomyopathy. Am Heart J 2007;153:105-12.PubMedCrossRef

11.

Khan FZ, Virdee MS, Palmer CR, Pugh PJ, O’Halloran D, Elsik M, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: The TARGET study: A randomized, controlled trial. J Am Coll Cardiol 2012;59:1509.PubMedCrossRef

12.

Auricchio A, Stellbrink C, Block M, Sack S, Vogt J, Bakker P, et al. Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure. Circulation 1999;99:2993-3001.PubMedCrossRef

13.

Touiza A, Etienne Y, Gilard M, Fatemi M, Mansourati J, Blanc JJ. Long-term left ventricular pacing: Assessment and comparison with biventricular pacing in patients with severe congestive heart failure. J Am Coll Cardiol 2001;38:1966-70.PubMedCrossRef

14.

Gage RM, Burns KV, Vatterott DB, Kubo SH, Bank AJ. Pacemaker optimization in nonresponders to cardiac resynchronization therapy: Left ventricular pacing as an available option. Pacing Clin Electrophysiol 2012;35:685-94.PubMedCrossRef

15.

Sweeney MO, Prinzen FW. A new paradigm for physiologic ventricular pacing. J Am Coll Cardiol 2006;47:282-8.PubMedCrossRef

16.

Lin X, Xu H, Zhao X, Folks RD, Garcia EV, Soman P, et al. Repeatability of left ventricular dyssynchrony and function parameters in serial gated myocardial perfusion SPECT studies. J Nucl Cardiol 2010;17:811-6.PubMedCrossRef

Title: Deterioration of left ventricular ejection fraction and contraction synchrony during right ventricular pacing in patients with left bundle branch block
Authors: Mati Friehling, MD
Daniel R. Ludwig, ScB
Michael Dunn, ScB
Donald Siddoway, MD
Prem Soman, MD, PhD
David Schwartzman, MD
Publication date: 01-10-2013
Publisher: Springer US
Published in: Journal of Nuclear Cardiology / Issue 5/2013
Print ISSN: 1071-3581
Electronic ISSN: 1532-6551
DOI: https://doi.org/10.1007/s12350-013-9752-9

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Deterioration of left ventricular ejection fraction and contraction synchrony during right ventricular pacing in patients with left bundle branch block

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Background

Methods

Results

Conclusions

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