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Journal of Cardiovascular and Thoracic Research
ISSN: 2008-5117      eISSN: 2008-6830  
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Article History
Submitted: 14 Jun 2015
Accepted: 09 Jan 2016
First published online: 14 Mar 2016

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J Cardiovasc Thorac Res. 2016;8(1):20-25 doi: 10.15171/jcvtr.2016.04
PMID:27069563        PMCID:PMC4827135

Radial left ventricular dyssynchrony by speckle tracking in apical versus non apical right ventricular pacing- evidence of dyssynchrony on medium term follow up

Original Article

Dinesh Choudhary 1, Amit Kumar Chaurasia 1 * , S. Mahesh Kumar 1, Ajeet Arulkumar 1, Anees Thajudeen 1, Narayanan Namboodiri 1, G Sanjay 1, SP Abhilash 1, VK Ajitkumar 1, Tharakan JA 1

1 Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum 695 011, Kerala, India



Abstract
Introduction: To study effects of various sites of right ventricular pacing lead implantation on left ventricular function by 2-dimensional (2D) speckle tracking for radial strain and LV dyssynchrony. Methods: This was retrospective prospective study. Fifteen patients each with right ventricular (RV) apical (RV apex and apical septum) and non-apical (mid septal and low right ventricular outflow tract [RVOT]) were programmed to obtain 100% ventricular pacing for evaluation by echo. Location and orientation of lead tip was noted and archived by fluoroscopy. Electrocardiography (ECG) was archived and 2D echo radial dyssynchrony was calculated.
Results: The baseline data was similar between two groups. Intraventricular dyssynchrony was significantly more in apical location as compared to non-apical location (radial dyssynchrony: 108.2 ± 50.2 vs. 50.5 ± 24, P < 0.001; septal to posterior wall delay [SLWD] 63.5 ± 27.5 vs. 34 ± 10.7, P < 0.001, SPWD 112.5 ± 58.1 vs. 62.7 ± 12.1, P = 0.003). The left ventricular ejection fraction was decreased more in apical location than non apical location. Interventricular dyssynchrony was more in apical group but was not statistically significant. The QRS duration, QTc and lead thresholds were higher in apical group but not statistically significant.
Conclusion: Pacing in non apical location (RV mid septum or low RVOT) is associated with less dyssynchrony by specific measures like 2D radial strain and correlates with better ventricular function in long term.






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