Impact of asynchronous ventricular activation on pro-inflammatory cytokines and oxidative stress in paced patients

• Published in: Heart (British Cardiac Society) 2005-06, Vol.91 (6), p.817-818
• Main Authors: Marketou, M E, Simantirakis, E N, Nikitovic, D, Chrysostomakis, S I, Zacharis, E A, Vardas, P E
• Format: Article
• Language: English
• Subjects: asynchronous ventricular activation; AVA; Biological and medical sciences; Cardiac Pacing, Artificial - methods; Cardiology. Vascular system; Confidence intervals; Cytokines; Cytokines - metabolism; Electrocardiography; Female; Heart Block - metabolism; Heart Block - therapy; Heart Ventricles; Humans; IL-6; interleukin-6; Interleukin-6 - metabolism; lipid peroxides; Lipid Peroxides - metabolism; Male; Medical sciences; Middle Aged; Oxidative stress; Oxidative Stress - physiology; Physiology; Plasma; RAVP; right apical ventricular pacing; Scientific Letters; Sick Sinus Syndrome - metabolism; Sick Sinus Syndrome - therapy; Sinuses; TNFα; Tumor Necrosis Factor-alpha - metabolism; tumour necrosis factor α; Variance analysis
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2004.039925

Asynchronous ventricular activation (AVA), caused by right apical ventricular pacing (RAVP), results in the deterioration of both systolic and diastolic function. 1, 2 Chronic RAVP under DDDR pacing mode in patients with sick sinus syndrome revealed a detrimental effect on left ventricular fractional shortening, left atrium dilation, and myocardial blood flow. 3, 4 Furthermore, although the mechanism has not been fully elucidated, pro-inflammatory cytokines and oxidative stress have been shown, in both experimental and clinical studies, to affect the myocardium, compromising ventricular systolic performance. 5 We hypothesised that these two latter factors are implicated in the functional and metabolic abnormalities in patients with AVA caused by RAVP. Published studies demonstrate that preserving the normal ventricular activation sequence acutely improves the cardiac systolic and diastolic performances and myocardial blood flow. 1, 2, 4 On the other hand, it has been postulated that pro-inflammatory cytokines and oxidative stress are increased during ventricular dysfunction. 5 Thus, the haemodynamically advantageous AAIR pacing may prevent the deleterious production of increased IL-6 and LP.