CLINICAL RESEARCH: PACING AND CARDIAC FUNCTION
Ventricular Pacing Lead Location Alters Systemic Hemodynamics and Left Ventricular Function in Patients With and Without Reduced Ejection Fraction
Randy Lieberman, MD*,*,
Luigi Padeletti, MD ,
Jan Schreuder, MD ,
Kenneth Jackson, PA*,
Antonio Michelucci, MD,
Andrea Colella, MD,
William Eastman, MS ,
Sergio Valsecchi, BS and
Douglas A. Hettrick, PhD
* Harper Hospital, Detroit, Michigan
University of Florence, Florence, Italy
San Raffaele University Hospital, Milan, Italy
Medtronic, Inc., Minneapolis, Minnesota
Manuscript received December 26, 2005;
revised manuscript received April 17, 2006,
accepted April 25, 2006.
* Reprint requests and correspondence: Dr. Randy Lieberman, Department of Cardiology, Harper University Hospital, 3990 John R, Detroit, Michigan 48201 (Email: rlieberm{at}dmc.org).
OBJECTIVES: We compared left ventricular (LV) systolic and diastolic function during right ventricular (RV), LV, and biventricular (BiV) pacing in patients with narrow QRS duration with and without LV dysfunction.
BACKGROUND: The optimal RV pacing lead location for patients with a standard indication for ventricular pacing remains controversial.
METHODS: Left ventricular pressure and volume data were determined via conductance catheter during electrophysiology study in 31 patients divided into groups with ejection fraction (EF)  40% (n = 17) or EF <40% (n = 14). QRS duration was 91 ± 18 versus 106 ± 25 ms, respectively (p = NS). Hemodynamic data were recorded during atrial and dual chamber pacing from the RV apex, RV free wall, RV septum, LV free wall, and BiV.
RESULTS: In patients with EF 40%, RV pacing at 1 or more sites, but not LV free wall or BiV pacing, significantly (p < 0.05) impaired cardiac output (CO), stroke work (SW), EF, and LV relaxation compared with atrial overdrive pacing. Right ventricular pacing also impaired hemodynamics and LV function in patients with EF <40%. However, LV and BiV pacing increased CO, SW, EF, and LV +dP/dtMAX in patients with LV dysfunction. Left ventricular and BiV pacing enhanced an index of global LV cycle efficiency in patients with depressed EF. The detrimental hemodynamic effects of RV pacing were attenuated by selecting the optimal RV pacing site.
CONCLUSIONS: Right ventricular pacing worsens LV function in patients with and without LV dysfunction unless the RV pacing site is optimized. Left ventricular and BiV pacing preserve LV function in patients with EF >40% and improve function in patients with EF <40% despite no clinical indication for BiV pacing.
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Abbreviations and Acronyms
| | AAI = atrial overdrive pacing | | AV = atrioventricular | | BiV = biventricular | | CE = cycle efficiency | | DYS = dyssynchrony index | | EF = ejection fraction | | LV = left ventricular | | LVEDP = left ventricular end-diastolic pressure | | LVF = left ventricular free wall | | LVSP = left ventricular systolic pressure | | RCE = regional cycle efficiency | | RV = right ventricular | | RVA = right ventricular apex | | RVF = right ventricular outflow tract free wall | | RVOT = right ventricular outflow tract | | RVS = right ventricular outflow tract septum | | SV = stroke volume | | SW = stroke work |
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