Intraventricular flow patterns during right ventricular apical pacing

Francesco Bianco, Vincenzo Cicchitti, Valentina Bucciarelli, Alvin Chandra, Enrico Di Girolamo, Gianni Pedrizzetti, Gianni Tonti, Silvio Romano, Raffaele De Caterina, Sabina Gallina

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2 Scopus citations

Abstract

Objectives To assess differences in blood flow momentum (BFM) and kinetic energy (KE) dissipation in a model of cardiac dyssynchrony induced by electrical right ventricular apical (RVA) stimulation compared with spontaneous sinus rhythm. Methods We cross-sectionally enrolled 12 consecutive patients (mean age 74±8 years, 60% male, mean left ventricular ejection fraction 58%±6 %), within 48 hours from pacemaker (PMK) implantation. Inclusion criteria were: age>18 years, no PMK-dependency, sinus rhythm with a spontaneous narrow QRS at the ECG, preserved ejection fraction (>50%) and a low percentage of PMK-stimulation (<20%). All the participants underwent a complete echocardiographic evaluation, including left ventricular strain analysis and particle image velocimetry. Results Compared with sinus rhythm, BFM shifted from 27±3.3 to 34±7.6° (p=0.016), while RVA-pacing was characterised by a 35% of increment in KE dissipation, during diastole (p=0.043) and 32% during systole (p=0.016). In the same conditions, left ventricle global longitudinal strain (LV GLS) significantly decreased from 17±3.3 to 11%±2.8% (p=0.004) during RVA-stimulation. At the multivariable analysis, BFM and diastolic KE dissipation were significantly associated with LV GLS deterioration (Beta Coeff.=0.54, 95% CI 0.07 to 1.00, p=0.034 and Beta Coeff.=0.29, 95% CI 0.02 to 0.57, p=0.049, respectively). Conclusions In RVA-stimulation, BFM impairment and KE dissipation were found to be significantly associated with LV GLS deterioration, when controlling for potential confounders. Such changes may favour the onset of cardiac remodelling and sustain heart failure.

Original languageEnglish (US)
Article numbere001057
JournalOpen Heart
Volume6
Issue number1
DOIs
StatePublished - May 1 2019

Keywords

  • blood flow momentum
  • cardiac dyssynchrony
  • heart failure
  • intraventricular flow patterns
  • right ventricular pacing

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Bianco, F., Cicchitti, V., Bucciarelli, V., Chandra, A., Di Girolamo, E., Pedrizzetti, G., Tonti, G., Romano, S., De Caterina, R., & Gallina, S. (2019). Intraventricular flow patterns during right ventricular apical pacing. Open Heart, 6(1), [e001057]. https://doi.org/10.1136/openhrt-2019-001057