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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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CLINICAL RESEARCH

Right Ventricular Pacing Can Induce Ventricular Dyssynchrony in Patients With Atrial Fibrillation After Atrioventricular Node Ablation

Laurens F. Tops, MD, Martin J. Schalij, MD, PhD, Eduard R. Holman, MD, PhD, Lieselot van Erven, MD, PhD, Ernst E. van der Wall, MD, PhD and Jeroen J. Bax, MD, PhD*

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.

Abbreviations and Acronyms
  AF = atrial fibrillation
  AV = atrioventricular
  LV = left ventricle/ventricular
  NYHA = New York Heart Association
  RV = right ventricle/ventricular
  SPWMD = septal-to-posterior wall motion delay
  TDI = tissue Doppler imaging


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