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J Am Coll Cardiol, 2006; 48:1642-1648, doi:10.1016/j.jacc.2006.05.072
(Published online 26 September 2006). © 2006 by the American College of Cardiology Foundation |
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Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
Manuscript received January 11, 2006; revised manuscript received April 26, 2006, accepted May 1, 2006.
* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands. (Email: jbax{at}knoware.nl).
OBJECTIVES: This study was designed to assess the effects of long-term right ventricular (RV) pacing on left ventricular (LV) dyssynchrony, LV function, and heart failure symptoms.
BACKGROUND: Atrioventricular (AV) node ablation and subsequent long-term RV pacing is a well-established treatment option in patients with atrial fibrillation (AF).
METHODS: In 55 patients with drug-refractory AF, AV node ablation and implantation of a pacemaker was performed. At baseline and after a mean of 3.8 ± 1.7 years, LV dyssynchrony (by M-mode echocardiography and tissue Doppler imaging), LV function, and volumes and functional status were assessed.
RESULTS: After long-term RV pacing, 27 patients (49%) had developed LV dyssynchrony. Concomitantly, these patients worsened in heart failure symptoms (New York Heart Association functional class increased from 1.8 ± 0.6 to 2.2 ± 0.7, p < 0.05), with a decrease in LV ejection fraction (from 48 ± 7% to 43 ± 7%, p < 0.05) and an increase in LV end-diastolic volume (from 116 ± 39 ml to 130 ± 52 ml, p < 0.05). Conversely, patients without LV dyssynchrony did not deteriorate in heart failure symptoms, LV function, or LV volumes.
CONCLUSIONS: Long-term RV pacing can induce LV dyssynchrony in almost 50% of patients treated with AV node ablation for chronic AF. The development of LV dyssynchrony was associated with deterioration in heart failure symptoms, systolic LV function, and LV dilatation.
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