Left ventricular mechanics in conduction system pacing versus right ventricular pacing.
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All Authors
Partheban, M.
Abdul Samad, N.H.
Ahmad, S.
Paton, M.F.
LTHT Author
Paton, Maria
LTHT Department
Cardio-Respiratory
Cardiology
Cardiology
Non Medic
Highly Specialist Cardiac Physiologist
Publication Date
2025
Item Type
Conference Abstract
Language
Subject
ADULT , AGED , BRADYCARDIA , CONTROLLED CLINICAL TRIALS AS TOPIC , DRUG THERAPY , ECHOCARDIOGRAPHY , WOMEN , FOLLOW-UP-STUDIES , HEART FAILURE , HEART , CARDIAC PACING, ARTIFICIAL , MEN
Subject Headings
Abstract
Funding Acknowledgement: NIHR Clinical Lectureship (NIHR301225). Introduction: For 60 years, right ventricular pacing (RVP) has dominated treatment options for bradyarrhythmia but has been associated with adverse left ventricular (LV) remodelling and increased heart failure risk. Conduction system pacing (CSP) is a potential alternative pacing approach, though its effectiveness in reducing LV dyssynchrony is uncertain. Echocardiography is an essential tool for providing insights into LV function and mechanics. Aim(s): To compare mechanical dyssynchrony in patients receiving CSP or RVP using modern echocardiographic myocardial work (MW) measurements. Method(s): Patients with atrioventricular block requiring pacemakers were prospectively recruited from October 2022 to October 2023 at a UK tertiary hospital. Patients receiving CSP were age and sex matched with patients receiving RVP. Data were collected at pre-implant (baseline), 0-6 weeks post-implant (acute), and 6 months post-implant (mid-term). The primary outcome was within-patients changes in septal and lateral MW indices between the groups. Result(s): Sixteen patients (CSP n = 8, RVP n = 8), 76% male with a mean age 65 (+/- 11) years, were included for analysis. After a median follow-up of 27 weeks (IQR: 23-31), A significant time interaction effect in septal MW index was found between CSP and RVP groups (p = 0.04). Septal (1411 +/- 198 to 1446 +/- 178 mmHg%) and lateral work (1835 +/- 263 to 1890 +/- 243 mmHg%) was similar at baseline and across follow-up in those receiving CSP, whereas RVP patients had a significant decrease in septal work (1621 +/- 198 to 954 +/- 178 mmHg%) and an increase in lateral work (1283 +/- 263 to 1788 +/- 243 mmHg%) over time. Conclusion(s): Regional LV wall analysis is required beyond global LV systolic function assessment to assess early changes in cardiac mechanics following pacemaker therapy initiation. Our data suggest CSP better preserves septal MW compared to RVP in age and sex matched individuals, potentially offering mechanistic insights into the effects of various bradycardia pacing strategies.
Journal
Echo Research and Practice