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AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing?
Some patients with pacemakers present with first-degree atrioventricular (AV) block. To avoid right ventricular (RV) pacing, preserving intrinsic AV conduction as much as possible is recommended. However, there is no clear cutoff AV interval to determine whether intrinsic AV conduction should be pre...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer Japan
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239935/ https://www.ncbi.nlm.nih.gov/pubmed/35133499 http://dx.doi.org/10.1007/s00380-022-02037-8 |
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author | Aizawa, Yoshihiro Nakai, Toshiko Ikeya, Yukitoshi Kogawa, Rikitake Saito, Yuki Toyama, Kazuto Yumikura, Tetsuro Otsuka, Naoto Nagashima, Koichi Okumura, Yasuo |
author_facet | Aizawa, Yoshihiro Nakai, Toshiko Ikeya, Yukitoshi Kogawa, Rikitake Saito, Yuki Toyama, Kazuto Yumikura, Tetsuro Otsuka, Naoto Nagashima, Koichi Okumura, Yasuo |
author_sort | Aizawa, Yoshihiro |
collection | PubMed |
description | Some patients with pacemakers present with first-degree atrioventricular (AV) block. To avoid right ventricular (RV) pacing, preserving intrinsic AV conduction as much as possible is recommended. However, there is no clear cutoff AV interval to determine whether intrinsic AV conduction should be preserved or RV pacing should be delivered. This study aimed to compare a pacing mode-preserving, intrinsic AV conduction with the DDD mode delivering RV pacing in terms of echocardiographic parameters in patients with first-degree AV block and to investigate whether RV pacing induces heart failure (HF). Stroke volume (SV) was measured to determine the optimal AV delay with the intrinsic AV conduction rhythm and the DDD pacing delivering RV pacing. Echocardiographic evaluation was performed for 6-month follow-up period. Seventeen patients were studied. At baseline, mean intrinsic PQ interval was 250 ± 40 ms. SV was greater with RV pacing with optimal AV delay of 160 ms than with intrinsic AV conduction rhythm in all patients. Therefore, pacemakers were set to the DDD to deliver RV pacing. During follow-up, seven patients developed HF. Mean baseline E/E′ ratio in patients who developed HF (HF group) during RV pacing was higher than in patients without HF (non = HF group; 17.9 ± 8 versus 11.5 ± 2, P = 0.018) Even within HF group patients without a high baseline E/E′ ratio, it increased with RV pacing (22.2 ± 6 versus 11.6 ± 2; P < 0.001). In patients with pacemaker and first-degree AV block, RV pacing with the optimal AV delay of 160 ms increased SV. However, the risk of HF may be increased with RV pacing if the E/Eʹ ratio is > 15 during intrinsic AV conduction or RV pacing. RV pacing should be avoided in patients with high E/Eʹ ratio under intrinsic AV conduction or RV pacing. |
format | Online Article Text |
id | pubmed-9239935 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Springer Japan |
record_format | MEDLINE/PubMed |
spelling | pubmed-92399352022-06-30 AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? Aizawa, Yoshihiro Nakai, Toshiko Ikeya, Yukitoshi Kogawa, Rikitake Saito, Yuki Toyama, Kazuto Yumikura, Tetsuro Otsuka, Naoto Nagashima, Koichi Okumura, Yasuo Heart Vessels Original Article Some patients with pacemakers present with first-degree atrioventricular (AV) block. To avoid right ventricular (RV) pacing, preserving intrinsic AV conduction as much as possible is recommended. However, there is no clear cutoff AV interval to determine whether intrinsic AV conduction should be preserved or RV pacing should be delivered. This study aimed to compare a pacing mode-preserving, intrinsic AV conduction with the DDD mode delivering RV pacing in terms of echocardiographic parameters in patients with first-degree AV block and to investigate whether RV pacing induces heart failure (HF). Stroke volume (SV) was measured to determine the optimal AV delay with the intrinsic AV conduction rhythm and the DDD pacing delivering RV pacing. Echocardiographic evaluation was performed for 6-month follow-up period. Seventeen patients were studied. At baseline, mean intrinsic PQ interval was 250 ± 40 ms. SV was greater with RV pacing with optimal AV delay of 160 ms than with intrinsic AV conduction rhythm in all patients. Therefore, pacemakers were set to the DDD to deliver RV pacing. During follow-up, seven patients developed HF. Mean baseline E/E′ ratio in patients who developed HF (HF group) during RV pacing was higher than in patients without HF (non = HF group; 17.9 ± 8 versus 11.5 ± 2, P = 0.018) Even within HF group patients without a high baseline E/E′ ratio, it increased with RV pacing (22.2 ± 6 versus 11.6 ± 2; P < 0.001). In patients with pacemaker and first-degree AV block, RV pacing with the optimal AV delay of 160 ms increased SV. However, the risk of HF may be increased with RV pacing if the E/Eʹ ratio is > 15 during intrinsic AV conduction or RV pacing. RV pacing should be avoided in patients with high E/Eʹ ratio under intrinsic AV conduction or RV pacing. Springer Japan 2022-02-08 2022 /pmc/articles/PMC9239935/ /pubmed/35133499 http://dx.doi.org/10.1007/s00380-022-02037-8 Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . |
spellingShingle | Original Article Aizawa, Yoshihiro Nakai, Toshiko Ikeya, Yukitoshi Kogawa, Rikitake Saito, Yuki Toyama, Kazuto Yumikura, Tetsuro Otsuka, Naoto Nagashima, Koichi Okumura, Yasuo AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title | AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title_full | AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title_fullStr | AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title_full_unstemmed | AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title_short | AV timing in pacemaker patients with first-degree AV block: which is preferable, intrinsic AV conduction or pacing? |
title_sort | av timing in pacemaker patients with first-degree av block: which is preferable, intrinsic av conduction or pacing? |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9239935/ https://www.ncbi.nlm.nih.gov/pubmed/35133499 http://dx.doi.org/10.1007/s00380-022-02037-8 |
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