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Europace Advance Access originally published online on October 31, 2009
Europace 2009 11(12):1660-1665; doi:10.1093/europace/eup322
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Pacing and CRT

The immediate effects of pacemaker-related electric remodelling on left ventricular function in patients with sick sinus syndrome

Yu-Chen Wang1,2, Yen-Hung Lin2, Yen-Bin Liu2, Jen-Kuang Lee2, Ying-Shren Chen2, Hsiu-Hao Lee3, Lung-Chun Lin2, Yi-Lwun Ho2,4,* and Wen-Jone Chen5

1 Division of Cardiology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; 2 Department of Internal Medicine and Emergency Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan; 3 Department of Internal Medicine, Taipei City Hospital, Zhongxing Branch, Taipei, Taiwan; 4 Department of Internal Medicine, Graduate Institute of Clinical Medicine, National Taiwan University Hospital, #7, Chung-Shan South Road, Taipei, Taiwan; 5 National Taiwan University College of Medicine, Taipei, Taiwan

Aims: The immediate effects of electric remodelling on the left ventricular (LV) function by dual-chamber pacemakers remain unknown. The purpose of our study was to assess the interaction between heart rates and right ventricular pacing (VP) on LV contractility and diastolic function.

Method and results: Twenty-five patients with dual-chamber pacemakers and sick sinus syndrome were evaluated. Echocardiographic examinations included standard and tissue-Doppler echocardiography at bilateral mitral annulus margins under either the intrinsic atrio-ventricular sequential conduction (ventricular sensing; VS) mode or right ventricular apical pacing (VP) mode. Under either mode, we accelerated the pacing rate at an increment of 15 b.p.m. step-by-step from 60 to 90/min. The tissue-Doppler echocardiography of mitral annulus showed that under the VS status, accelerating atrial pacing rate from 60 to 90 b.p.m. enhanced A'-wave velocity (P less double equals 0.002), whereas no significant change of LV ejection fraction (LVEF) and E'-wave velocity were noted. Under the VP status, acceleration of pacing rates exerted no effect on the LVEF, E'-, and A'-wave (P = NS). While shifting the pacemaker mode from VS to VP, the E'-wave velocity (P less double equals 0.002) and E'/A' ratio decreased significantly (P less double equals 0.001). The A'-wave velocity also increased significantly during shifting to VP mode at 60 b.p.m. (P less double equals 0.004).

Conclusion: At fixed pacing rates, shifting from VS to VP mode impaired LV diastolic function immediately with preserved LV contractility. The acceleration of heart rate impaired LV diastolic function under VS mode.

Key Words: Dyssynchronization, Diastolic dysfunction, Sick sinus syndrome, Pacemaker, Heart rate, Echocardiography, Tissue Doppler

* Corresponding author. Tel: +886 2 2312 3456, Email: ylho{at}ntu.edu.tw

Manuscript submitted 12 July 2009. Accepted after revision 23 September 2009.


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