Single versus dual chamber pacing in the young: noninvasive comparative evaluation of cardiac function

The advantages of atrial synchrony over asynchronous ventricular pacing remain unclear in the young, chronically right ventricular (RV) - paced patient. This is in contrast to the older patient with inherent diastolic dysfunction who has been shown to benefit from atrial synchrony with dual chamber...

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Bibliographic Details
Published in:Pacing and clinical electrophysiology 2003-05, Vol.26 (5), p.1208-1211
Main Authors: Horenstein, M Silvana, Karpawich, Peter P, Tantengco, M Victoria T
Format: Article
Language:English
Subjects:
Adolescent
Adult
Cardiac Pacing, Artificial - methods
Child
Echocardiography
Electrocardiography
Female
Heart Block - diagnostic imaging
Heart Block - physiopathology
Heart Block - therapy
Humans
Male
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Summary:The advantages of atrial synchrony over asynchronous ventricular pacing remain unclear in the young, chronically right ventricular (RV) - paced patient. This is in contrast to the older patient with inherent diastolic dysfunction who has been shown to benefit from atrial synchrony with dual chamber (DDD,R/VDD), over single chamber rate response (VVI,R) ventricular pacing. The goal of this study was to noninvasively assess cardiac function in a group of young, RV-paced patients before and after establishment of atrial synchrony. Echocardiographic data were retrospectively analyzed from 10 patients with congenital or acquired complete AV block, who were VVI,R paced for 10.2 +/- 2 years (mean age at study 19.2 +/- 8.9 years), and were subsequently converted to DDD,R/VDD pacing (mean age at study 20.7 +/- 9.5 years). Paired t-test analysis of left ventricular (LV) systolic and diastolic function during VVI,R versus DDD,R/VDD pacing did not result in any short-term difference in LV short axis fractional area of change or FAC (53% +/- 7.5% vs 56.8% +/- 8.7%) or mitral maximal velocity (E) normalized to mitral flow velocity time integral (VTI) (5.2/s +/- 1.5 vs 4.4/s +/- 1.5). A decrease in mitral flow E/A ratio was observed after short-term DDD,R/VDD pacing (2.2 +/- 0.5 vs 1.9 +/- 0.3). Atrial synchronous dual chamber pacing in young patients with complete AV block does not lead to any appreciable early change in global LV function over single-site RV pacing. Therefore, early establishment of atrial synchrony in the young asymptomatic VVI,R-paced patient with normal intrinsic ventricular function may not be warranted.
ISSN:0147-8389
1540-8159
DOI:10.1046/j.1460-9592.2003.t01-1-00170.x