Reducing Aortic Barotrauma and Vascular Extracellular Matrix Degradation by Pacemaker-Mediated QRS Widening

• Published in: Journal of the American Heart Association 2020-05, Vol.9 (10), p.e014804-e014804
• Main Authors: Sezer, Murat, Atici, Adem, Coskun, Isa, Cizgici, Yaşar, Ozcan, Alp, Umman, Berrin, Bugra, Zehra, Ozcan, Ilke, Hasdemir, Hakan, Kocaaga, Mehmet, Davies, Justin E, Umman, Sabahattin
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aorta - metabolism; Aorta - pathology; Aorta - physiopathology; aortic aneurysm; Aortic Diseases - metabolism; Aortic Diseases - pathology; Aortic Diseases - physiopathology; Aortic Diseases - prevention & control; Arrhythmias, Cardiac - diagnosis; Arrhythmias, Cardiac - physiopathology; Arrhythmias, Cardiac - therapy; Arterial Pressure; Barotrauma - metabolism; Barotrauma - pathology; Barotrauma - physiopathology; Barotrauma - prevention & control; Cardiac Pacing, Artificial; dP/dt; Extracellular Matrix - metabolism; Extracellular Matrix - pathology; Female; Humans; Male; Matrix Metalloproteinase 9 - blood; matrix metalloproteinases; Mechanotransduction, Cellular; Middle Aged; Original Research; Pacemaker, Artificial; pacing; Prospective Studies; Stress, Mechanical; Treatment Outcome; Vascular Remodeling; Ventricular Function, Left; Ventricular Pressure
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.119.014804

Background The extent of pressure-related damage might be related to acceleration rate of the applied pressure (peak dP/dt) in the vascular system. In this study, we sought to determine whether dP/dt applied to the aortic wall (aortic dP/dt) and in turn vascular extracellular matrix degradation can be mitigated via modulation of left ventricular (LV) contractility (LV dP/dt) by pacemaker-mediated desynchronization. Methods and Results First, in 34 patients, changes in aortic dP/dt values in 3 aortic segments in response to pacemaker-mediated stepwise QRS widening leading to gradual desynchronization of the LV contraction by means of steadily changed atrioventricular delay (AVD) with temporary dual-chamber pacing was examined before and after beta-blocker (15 mg IV metoprolol) administration. Second, serum matrix metalloproteinase-9 levels were measured in the 20 patients with permanent pacemaker while they were on sinus rhythm with normal QRS width and 3 weeks after wide QRS rhythm ensured by dual pacing, dual sensing, and dual response to sensing with short AVD. LV dP/dt substantially correlated with dP/dt measured in ascending ( =0.83), descending ( =0.89), and abdominal aorta ( =0.96). QRS width strongly correlated with dP/dt measured in ascending ( =-0.95), descending ( =-0.92), and abdominal ( =-0.96) aortic segments as well. In patients with permanent pacemaker, wide QRS rhythm led to a significant reduction in serum matrix metalloproteinase-9 levels (from 142.5±32.9 pg/mL to 87.5±32.4 pg/mL [