Dynamic and site-specific impact of ventricular pacing on left ventricular ejection fraction

David Schwartzman, Lauren Johnson, Hidekazu Tanaka, Takeyoshi Ota, John Gorcsan, Bouchra Lamia, Michael R. Pinsky, Sanjeev G. Shroff

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Background: Some studies suggest that right ventricular (RV) pacing has an adverse impact on left ventricular ejection fraction (LVEF), particularly in subjects with preexisting left ventricular (LV) dysfunction, and that direct LV pacing may be relatively protective. Interactions between pacing site and LVEF remain unclear. Objective: The purpose of this study was to examine the relative impact of RV and LV pacing on LVEF by serial study during a period in which LV dysfunction, induced by tachypacing, was introduced and then resolved. Methods: In each of five dogs, RV, LV, and simultaneous RV and LV (BiV) pacing modes were compared to native ventricular activation (1) prior to tachypacing (baseline), (2) weekly during a 5-week continuous tachypacing period, and (3) weekly during a 3-week post-tachypacing recovery period. At each evaluation, LVEF and LV contraction synchrony were assessed during each pacing mode. Results: The decrease in LVEF during the tachypacing period was more pronounced during RV pacing than during native activation or LV or BiV pacing. The magnitude of this effect correlated with a diminishment in LV contraction synchrony that was not observed during native activation or LV or BiV pacing. During the post-tachypacing period, gradual reversal of these changes toward baseline was observed. Conclusion: Compared to native activation, RV pacing worsens LVEF in a manner proportional to the severity of preexisting LV dysfunction, attributable to reduced LV contraction synchrony. In comparison, both LV and BiV pacing preserve LVEF and contraction synchrony.

Original languageEnglish
Pages (from-to)813-819
Number of pages7
JournalHeart rhythm
Volume7
Issue number6
DOIs
StatePublished - Jun 2010

Keywords

  • Contraction
  • Ejection fraction
  • Pacing
  • Resynchronization
  • Ventricle

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