Uticaj položaja pejsmejker elektrode na funkciju leve komore kod pacijenta sa permanentnim antibradikarnim pejsingom

Abstract

The aim of the study is an assessment of pace maker lead position in right ventricle outflow tract versus right ventricle apex, and the difference between these two regarding the left ventricle function in patients with standard antibradicardic indications for permanent pacing. Material end methods: the study was conducted on 132 patients with implanted antibradicardiac permanent pacemaker in Pacemaker center in Zajecar, during the period from November of 2009. To august of 2011. There were 61 VVI pace makers implanted (46.21%) and 71 DDD pace makers ( 53.80%). According to the lead position the patients were divided into two groups: RVA group with 61 patient, with passive fixation ventricle lead in right ventricle apex position. RVOT group with 71 patient, with active fixation lead in right ventricle outflow tract. The assessment of the patient functional status was done with Minnesota Living With Heart Failure Questionnaire, NYHA classification, 6 minute walking test. Left ventricle function was assessed using RNV and echocardiography. All the tests were done at the beginning and after 12 months. Results: One year after implantation, RVA patients had 531,59±272,30m (p=0,03) at 6MWT, whick is 92m more than the starting value. If we watch only the patinets in NYHA I ant II classes, we can see that these classes enveloped 33 pts (53,22%) in RVA group, and 40pts (55.57%) in RVOT group. After one year of follow up, the improvement is significant, and equal in both groups, 45pts (84.50%) was in RVA group, and 51pts (86.45%) was in RVOT group. Ther is no statistically significant influence of these groups (F=0,29; p=0,74) on MLWH score. In echocardiographic measurements in 2D mode, EDV of left ventricle was significantly higher in RVA group 129,33±46,72 cm3(p=0,003).ESV of left ventricle was enlarged in RVA group 63,26±27,63 cm3(Z=-2,70; p=0,007). EF was lower with statistical significance in RVA group to 51,22±8,74% (p=0,05). UV enlarged with statistical significance in RVOT group 75,76±24,30 cm3(p=0,03). UL was singificantlly higher in RVOT group 40,67±12,34 ml/m2(p=0,02). EDD was not changed in RVA group 5,12±0,49cm (p=0,67), while it was singnificantly higher in RVOT group5,26±0,62cm (p=0,01). ESD was unchanged in RVA group 3,43±0,60cm (p=0,53), while in the RVOT group it enlarged significantlly 3,64±0,68 cm (p=0,03). Data analysis from the beginning of the study and after one yer showed that in RVOT group there was a statistically significatn differen ce in diastolic disfunction (Z=-2,10; p=0,03). In RVA group,8 pts died (13.11%) , ant in RVOT group 11 (15.49%) (X2=0,15,p=0,69). Conclusions: The negative effect of pace maker stimulation from RVA on LV function was proved by extrapolated echocardiographic measurmentns in 2D mode. Th e advanteges of RVA position was was confirmed in 6MTH. Positive influence of of RVOT pacemaker srtimulation on LV function was confirmed with QRS duration shortening, increase in stroke volume, and stroke index of LV, and with significant lowering of number of atrial fibrillation episodes. The negative effect of pace maker stimulation from RVOT on LV function was found with indirect echocardiographic measurments in M mode, on LV diastolic function. There ws no difference between RVA and RVOT regarding the LV function: analasys of NYHA and MLWHF scores, LV systolic function measured with RNV and echocardiography in M mode, global LV paramethers, there was also no influence on individual diastolic paramethers, or no longer fluoroscopy times. There was no influence on overall mortality.