Paced Corrected QT Interval is Associated with Lv Diastolic Dysfunction in Patients With Permanent Pacemakers and Preserved Left Ventricular Ejection Fraction
Paced Düzeltilmiş QT İntervali Kalıcı Kalp Pili Olan Sol Ventrikül Ejeksiyon Fraksiyonu Korunmuş Hastalarda Sol Ventrikül Diyastolik Disfonksiyonu ile İlişkilidir
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Keywords:Paced QT interval, cardiac pacing, paced qrs width
Objective: Although chronic right ventricular apex (RVA) pacing is usually well tolerated in patients with normal cardiac function, recent studies report that not only left ventricular (LV) systolic function but also diastolic function is adversely affected. The aim of the present study was to detect the relationship between paced QRS, paced corrected QT (pQTc) duration, and echocardiographic parameters of LV diastolic dysfunction to examine the effects of RVA pacing in patients with preserved LV ejection fraction (LVEF).
Methods: We included 74 patients with LVEF>50% and DDD(R) pacemakers implanted for atrioventricular block (45 men and 29 women; mean age 64.9±11.6 years). Patients were included to the study at least 6 months after battery implantation. Patients with RVA pacing rate <70% were excluded from the study. Patients were classified into two groups according to the left atrial (LA) volume index.
Results: pQTc was associated with LA volume index, LA volume, LA end-diastolic diameter, E-wave deceleration time, septal annular e’ velocity, and mitral E/e’ ratio in bivariate analysis. The cut-off value of pQTc obtained by receiver operating characteristic curve analysis was 512 ms for prediction of increased (>34 mL/m²) LA volume index (sensitivity: 88.0% and specificity: 79.6%). The area under the curve was 0.848 (p<0.001).
Conclusion: pQTc duration was found to be significantly associated with the echocardiographic parameters of LV diastolic dysfunction. We suggest that pQTc be used as a marker to predict the risk of diastolic dysfunction after permanent pacemaker implantation in patients with preserved LVEF. It can also be used to optimize the RV pacing area with intraoperative measurement
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