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CLINICAL RESEARCH: ATRIAL FIBRILLATION

Left ventricular mechanics during right ventricular apical or left ventricular-based pacing in patients with chronic atrial fibrillation after atrioventricular junction ablation

Emmanuel N. Simantirakis, MD^*, Konstantinos E. Vardakis, MD^*, George E. Kochiadakis, MD^*, Emmanuel G. Manios, MD^*, Nikolaos E. Igoumenidis, MD^*, Michele Brignole, MD and Panos E. Vardas, MD, PhD, FACC^*,*

^* Cardiology Department, Heraklion University Hospital, Crete, Greece
Arrhythmologic Centre, Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy

Manuscript received June 9, 2003; revised manuscript received September 14, 2003, accepted October 6, 2003.

^* Reprint requests and correspondence: Dr. Panos E. Vardas, Cardiology Department, Heraklion University Hospital, P.O. Box 1352 Stavrakia, Heraklion, Crete, Greece.
cardio{at}med.uoc.gr

OBJECTIVES: The aim of the study was to evaluate whether left ventricular (LV) mechanics are better under LV-based pacing than under right ventricular (RV) apical pacing in patients with permanent atrial fibrillation (AF) after atrioventricular junction (AVJ) ablation.

BACKGROUND: "Ablate and pace" is an acceptable therapy for drug-refractory AF. However, the RV apical stimulation commonly used seems to interfere with the beneficial hemodynamic effect of regularization of heart rhythm.

METHODS: The study included 12 patients (5 men, mean age 62 ± 8.3 years), 6 with impaired and 6 with normal LV systolic function. All of them had a biventricular pacemaker system implanted and underwent atrioventricular node ablation for drug-refractory chronic AF. Using a conductance catheter, we analyzed LV pressure–volume loops during routine coronary angiography in order to evaluate short-term changes in LV mechanics during RV apical and LV-based (LV free wall or biventricular) pacing.

RESULTS: Compared with RV pacing, LV-based pacing significantly improved the indexes of LV systolic function (i.e., end-systolic pressure and volume, cardiac index, stroke work, preload recruitable stroke work, maximal rate of rise of LV pressure [dP/dt_max], LV ejection fraction, and end-systolic elastance). The LV diastolic filling indexes, end-diastolic pressure and volume, were better during LV-based pacing, whereas LV diastolic function indexes, –dP/dt_max, passive diastolic chamber stiffness, and time constant of LV isovolumic relaxation showed no clear change.

CONCLUSIONS: In the short term, LV-based pacing is superior to RV apical pacing in terms of contractile function and LV filling after AVJ ablation for drug-refractory AF.

Abbreviations and Acronyms   AF = atrial fibrillation   AVJ = atrioventricular junction   dP/dtmax = maximal rate of rise in left ventricular pressure   EDPVR = end-diastolic pressure–volume relation   LV = left ventricle/ventricular   PED = end-diastolic pressure   PES = end-systolic pressure   PRSW = preload recruitable stroke work   RV = right ventricle/ventricular   SW = stroke work   VED = end-diastolic volume   VES = end-systolic volume

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