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Usefulness of electrocardiographic and echocardiographic parameters for predicting the efficacy of atrioventricular synchronisation during a single lead VDD/R pacing.
Kardiol Pol 2009; 67(8A):1019-28KP

Abstract

BACKGROUND

The VDD/R pacing is accepted as an alternative to DDD/R pacing in patients with atrioventricular conduction block (AVB) and intact sinus node function.

AIM

To determine the relationship between parameters obtained during assessment of the patient for the implantation procedure, using electrocardiographic (ECG) and echocardiographic (ECHO) data, and the effectiveness of AV synchronisation.

METHODS

The study involved a group of 65 patients (43 males, 22 females), aged 66.6 + 12.7 with clinically significant disturbances of AV conduction, who did not reveal symptoms of concomitant abnormalities in sinus node automaticity. Selected ECG and ECHO parameters were studied prior to the implantation procedure. Repeat examinations were done at 3-4 days and at 1, 3, 6 and 12 months after the procedure. The effectiveness of AV synchronisation (PAS) has been estimated by event counter read-out and ECG Holter monitoring.

RESULTS

In 74% patients (subgroup A) synchronisation was highly effective (PAS _ 95%); in the remaining 26% subjects (subgroup B) PAS occasionally fell below 95%. In subgroup B, the P wave was longer than that in subgroup A (105 +/- 16 vs. 92 _ 13 ms; p < 0.05). The dimensions of the right and left heart chambers were greater in subgroup B. Patients in subgroup B had lower ejection fraction (49.4 +/- 13.7% in B vs. 58.2 +/- 11.3% in A) and revealed symptoms of heart failure. The following cut-off values for each echocardiographic and electrocardiographic parameter predisposing to PAS < 95% during VDD/R pacing ('undersensing') were identified: RVEDd > 26 mm, RVESd > 24 mm, LVEDd > 59 mm, LVESd > 37.3 mm, APD LA > 44 mm, SID RA > 52 mm, LMD RA > 48 mm, RAvol> 54 ml, RAarea > 19 cm2, SID LA > 57 mm, LMD LA > 46 mm, EF < 52%, P wave width > 100 ms. Significant predictors of PAS < 95% in the univariate analysis were RVEDd, RVESd, LVEDd, LMD RA, SID RA, RAvol, RAarea, EF, and in the multivariate analysis RVEDd, RVESd, LMD RA, RAarea, EF.

CONCLUSIONS

Selected parameters obtained from ECG (P wave width) and echo examinations are correlated with effective AV synchronisation. Enlargement of the right and left heart chambers (atrial, ventricular), reduction of the ejection fraction and congestive heart failure are associated with impaired AV synchronisation in VDD/R pacemakers. In multivariate analysis, only the higher dimensions of the right ventricle and atrium and the lower ejection fraction of the left ventricle were significantly associated with the PAS < 95%.

Authors+Show Affiliations

Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Collegium Medicum, John Paul II Hospital, Krakow, Poland.No affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19784907

Citation

Czunko, Agnieszka, et al. "Usefulness of Electrocardiographic and Echocardiographic Parameters for Predicting the Efficacy of Atrioventricular Synchronisation During a Single Lead VDD/R Pacing." Kardiologia Polska, vol. 67, no. 8A, 2009, pp. 1019-28.
Czunko A, Lelakowski J, Szczepkowski J. Usefulness of electrocardiographic and echocardiographic parameters for predicting the efficacy of atrioventricular synchronisation during a single lead VDD/R pacing. Kardiol Pol. 2009;67(8A):1019-28.
Czunko, A., Lelakowski, J., & Szczepkowski, J. (2009). Usefulness of electrocardiographic and echocardiographic parameters for predicting the efficacy of atrioventricular synchronisation during a single lead VDD/R pacing. Kardiologia Polska, 67(8A), pp. 1019-28.
Czunko A, Lelakowski J, Szczepkowski J. Usefulness of Electrocardiographic and Echocardiographic Parameters for Predicting the Efficacy of Atrioventricular Synchronisation During a Single Lead VDD/R Pacing. Kardiol Pol. 2009;67(8A):1019-28. PubMed PMID: 19784907.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Usefulness of electrocardiographic and echocardiographic parameters for predicting the efficacy of atrioventricular synchronisation during a single lead VDD/R pacing. AU - Czunko,Agnieszka, AU - Lelakowski,Jacek, AU - Szczepkowski,Jacek, PY - 2009/9/29/entrez PY - 2009/9/29/pubmed PY - 2010/7/29/medline SP - 1019 EP - 28 JF - Kardiologia polska JO - Kardiol Pol VL - 67 IS - 8A N2 - BACKGROUND: The VDD/R pacing is accepted as an alternative to DDD/R pacing in patients with atrioventricular conduction block (AVB) and intact sinus node function. AIM: To determine the relationship between parameters obtained during assessment of the patient for the implantation procedure, using electrocardiographic (ECG) and echocardiographic (ECHO) data, and the effectiveness of AV synchronisation. METHODS: The study involved a group of 65 patients (43 males, 22 females), aged 66.6 + 12.7 with clinically significant disturbances of AV conduction, who did not reveal symptoms of concomitant abnormalities in sinus node automaticity. Selected ECG and ECHO parameters were studied prior to the implantation procedure. Repeat examinations were done at 3-4 days and at 1, 3, 6 and 12 months after the procedure. The effectiveness of AV synchronisation (PAS) has been estimated by event counter read-out and ECG Holter monitoring. RESULTS: In 74% patients (subgroup A) synchronisation was highly effective (PAS _ 95%); in the remaining 26% subjects (subgroup B) PAS occasionally fell below 95%. In subgroup B, the P wave was longer than that in subgroup A (105 +/- 16 vs. 92 _ 13 ms; p < 0.05). The dimensions of the right and left heart chambers were greater in subgroup B. Patients in subgroup B had lower ejection fraction (49.4 +/- 13.7% in B vs. 58.2 +/- 11.3% in A) and revealed symptoms of heart failure. The following cut-off values for each echocardiographic and electrocardiographic parameter predisposing to PAS < 95% during VDD/R pacing ('undersensing') were identified: RVEDd > 26 mm, RVESd > 24 mm, LVEDd > 59 mm, LVESd > 37.3 mm, APD LA > 44 mm, SID RA > 52 mm, LMD RA > 48 mm, RAvol> 54 ml, RAarea > 19 cm2, SID LA > 57 mm, LMD LA > 46 mm, EF < 52%, P wave width > 100 ms. Significant predictors of PAS < 95% in the univariate analysis were RVEDd, RVESd, LVEDd, LMD RA, SID RA, RAvol, RAarea, EF, and in the multivariate analysis RVEDd, RVESd, LMD RA, RAarea, EF. CONCLUSIONS: Selected parameters obtained from ECG (P wave width) and echo examinations are correlated with effective AV synchronisation. Enlargement of the right and left heart chambers (atrial, ventricular), reduction of the ejection fraction and congestive heart failure are associated with impaired AV synchronisation in VDD/R pacemakers. In multivariate analysis, only the higher dimensions of the right ventricle and atrium and the lower ejection fraction of the left ventricle were significantly associated with the PAS < 95%. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/19784907/Usefulness_of_electrocardiographic_and_echocardiographic_parameters_for_predicting_the_efficacy_of_atrioventricular_synchronisation_during_a_single_lead_VDD/R_pacing_ DB - PRIME DP - Unbound Medicine ER -