Paced Düzeltilmiş QT İntervali Kalıcı Kalp Pili Olan Sol Ventrikül Ejeksiyon Fraksiyonu Korunmuş Hastalarda Sol Ventrikül Diyastolik Disfonksiyonu ile İlişkilidir

Amaç: Kronik sağ ventrikül apikal pacing, normal kardiyak fonksiyonlu hastalarda genellikle iyi tolere edilse de, son çalışmalarda sadece sol ventrikül sistolik fonksiyonunda değil diastolik fonksiyonda da olumsuz etkilenme saptanmıştır. Ejeksiyon fraksiyonu korunmuş hastalarda sağ ventrikül pacingin etkilerini incelemek için paced QRS, paced QTc süresi ve sol ventrikül diyastolik disfonksiyonunun ekokardiyografik parametreleri arasındaki ilişkiyi saptamayı amaçladık. Yöntemler: Sol ventrikül EF>%50 olan ve AV blok nedeniyle DDD(R) kardayak pacemaker implante edilmiş olan 74 hasta (45 erkek, 29 kadın; ortalama yaş 64,9±11,6 yıl) çalışmaya dahil edildi. Hastalar, pacemaker implantasyonundan en az 6 ay sonra çalışmaya dahil edildi. Sağ ventrikül apikal pacing oranı 34 mL/m2 ) sol atriyum hacim endeksi için pQTc’nin cut-off değeri 512 ms olarak bulundu (duyarlılık: %88,0, özgüllük: %79,6). Eğri altındaki alan 0,848 idi (p

Paced Corrected QT İnterval is Associated with Lv Diastolic Dysfunction in Patients With Permanent Pacemakers and Preserved Left Ventricular Ejection Fraction

Objective: Although chronic right ventricular apex (RVA) pacing is usually well tolerated in patients with normal cardiac function,recent studies report that not only left ventricular (LV) systolic function but also diastolic function is adversely affected. The aim ofthe present study was to detect the relationship between paced QRS, paced corrected QT (pQTc) duration, and echocardiographicparameters of LV diastolic dysfunction to examine the effects of RVA pacing in patients with preserved LV ejection fraction (LVEF).Methods: We included 74 patients with LVEF>50% and DDD(R) pacemakers implanted for atrioventricular block (45 men and 29women; mean age 64.9±11.6 years). Patients were included to the study at least 6 months after battery implantation. Patientswith RVA pacing rate 34 mL/m2) LA volume index (sensitivity: 88.0% and specificity: 79.6%). Thearea under the curve was 0.848 (p

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Kudenchuk PJ, Hallstrom AP, Herre JM, Wilkoff BL. Heart rate, pacing, and outcome in the Dual Chamber and VVI İmplantable Defibrillator (DAVID) trials. Heart Rhythm 2009; 6: 1129-35. [CrossRef]
Castelnuovo E, Stein K, Pitt M, Garside R, Payne E. The effectiveness and cost-effectiveness of dual-chamber pacemakers compared with single-chamber pacemakers for bradycardia due to atrioventricular block or sick sinus syndrome: systematic review and economic evaluation. Health Technol Assess 2005; 9: 1-246. [CrossRef]
Xie JM, Fang F, Zhang Q, Sanderson JE, Chan JY, Lam YY et al. Acute effects of right ventricular apical pacing on left atrial remodeling and function. Pacing Clin Electrophysiol 2012; 35: 856-62. [CrossRef]
Xie JM, Fang F, Zhang Q, Chan JYS, Yip GW, Sanderson JE, et al. Left atrial remodeling and reduced atrial pump function after chronic right ventricular apical pacing in patients with preserved ejection fraction. Int J Cardiol 2012;157: 364-9. [CrossRef]
Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms J Am Soc Echocardiogr 1989; 2: 358-67. [CrossRef]
Al-Khatib SM, LaPointe NM, Kramer JM, Califf RM. What clinicians should know about the QT interval, JAMA 2003; 2120-7. [CrossRef]
Wiegand UK, Potratz J, Bode F, Schreiber R, Bonnemeier H, Peters W, Katus HA. Cost-effectiveness of dual-chamber pacemaker therapy: does single lead VDD pacing reduce treatment costs of atrioventricular block? Eur Heart J 2001;22: 174-80. [CrossRef]
O’Brien BJ, Blackhouse G, Goeree R, Healey JS, Roberts RS, Gent M, et al. Cost-effectiveness of physiologic pacing: results of the Canadian Health Economic Assessment of Physiologic Pacing. Heart Rhythm 2005; 2: 270-5. [CrossRef]
Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107: 2932-7. [CrossRef]
Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288: 3115-23. [CrossRef]
Thackray SD, Witte KK, Nikitin NP, Clark AL, Kaye GC, Cleland JG. The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population. Eur Heart J 2003; 24: 1143-52. [CrossRef]
Thambo JB, Bordachar P, Garrigue S, Lafitte S, Sanders P, Reuter S, et al. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004; 110: 3766-72. [CrossRef]
Gillis AM. Redefining physiologic pacing: lessons learned from recent clinical trials. Heart Rhythm 2006; 3: 1367-72. [CrossRef]
Miyoshi F, Kobayashi Y, Itou H, Onuki T, Matsuyama T, Watanabe N, et al. Prolonged paced QRS duration as a predictor for congestive heart failure in patients with right ventricular apical pacing. Pacing Clin Electrophysiol 2005; 28: 1182-8. [CrossRef]
Pan W, Su Y, Gong X, Sun A, Shu X, Ge J. Value of the paced QRS duration. J Card Fail 2009; 15: 347-52. [CrossRef]
Park YM, Kim SJ, Park CH, Kang WC, Shin MS, Koh KK, et al. Repeated aborted sudden cardiac death with long qt syndrome in a patient with anomalous origin of the right coronary artery from the left coronary cusp. Kor ean Circ J 2013; 43: 830-3. [CrossRef]
Gray B, Ingles J, Medi C, Semsarian C. Prolongation of the QTc interval predicts appropriate implantable cardioverter-defibrillator therapies in hypertrophic cardiomyopathy, JACC Heart Fail 2013; 149-55. [CrossRef]
Chugh SS, Reinier K, Singh T, Uy-Evanado A, Socoteanu C, Peters D et al. Determinants of prolonged QT interval and their contribution to sudden death risk in coronary artery disease: the Oregon Sudden Unexpected Death Study, Circulation 2009; 119: 663-70. [CrossRef]
Straus SM, Kors JA, De Bruin ML, van der Hooft CS, Hofman A, Heeringa J et al. Prolonged QTc interval and risk of sudden cardiac death in a population of older adults, J Am Coll Cardiol 2006: 47: 362-7. [CrossRef]
Lee JM, Janardhan AH, Kang KW, Joung B, Pak HN, Sundaram S et al. Paced QT interval is a better predictor of mortality than the intrinsic QT interval: long-term follow-up study, Heart Rhythm 2014; 11: 1184-9. [CrossRef]
Cho EJ, Park SJ, Park KM, On YK, Kim JS. Paced QT interval as a risk factor for new-onset left ventricular systolic dysfunction and cardiac death after permanent pacemaker implantation. Int J Cardiol. 2016; 203: 158-63. [CrossRef]