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KMID : 1011920210220010011
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International Journal of Arrhythmia
2021 Volume.22 No. 1 p.11 ~ p.11
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Chronology of cardiac dysfunction after permanent pacemaker implantation: an observational 2 year prospective study in North India
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Gupta Harshit
Showkat Hakim Irfan
Aslam Naved
Tandon Rohit
Wander G. S.
Gupta Shweta
Anwar Sadaf
Sohil Mohd Maqbool
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Abstract
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Background: The purpose of this study is to evaluate cardiac functions using transthoracic echocardiography, change in lead parameters and electrocardiogram (ECG) morphology in patients undergoing permanent pacemaker implantation over a follow-up period of 6 months.
Methods: This is a prospective study in patients undergoing permanent pacemaker implantation in a tertiary care hospital. Patients undergoing permanent pacemaker implantation were enrolled for up to one year and Echocardiographic parameters (by 2 blind operators) and ECG parameters were recorded at admission (within 24 h), before discharge (within 7 days of pacemaker implantation), after 1 month (±?7 days) and after 6 months (±?7 days) of follow-up.
Results: A total of 96 patients (60.4% males and 39.6% female, mean age 66.65 years) were implanted with permanent pacemaker. The mean QRS duration was 133.18 ms and increased significantly to 146.03 ms by 6 months despite septal lead placement in majority (92%) of patients. The mean baseline ejection fraction of 51.47 decreased significantly to 47.83 by 6 months. Diastolic parameters like left atrial volume index, early to late diastolic transmitral flow velocity (E/A) and early diastolic mitral annular tissue velocity (E/e′) showed a significant increase (>?5%) from baseline by the end of first week. By the end of first month, systolic dysfunction of RV sets in with significant (>?5%) change from baseline in parameters like Right ventricle myocardial performance index, transannular plane systolic excursion and right ventricle systolic excursion velocity (RVS′).
Conclusion: We have observed that pacemaker recipients with baseline reduced left ventricle (LV) systolic functions perform significantly worse compared to those with baseline normal cardiac functions and had a higher rate of deterioration of LV function. RV dysfunction is the first abnormality that occurs, by 1 week followed by LV dysfunction which starts by 1 month and the diastolic dysfunctions precede the systolic dysfunction. QRS duration also showed a gradual increase despite septal lead placement in majority (92%) and lead parameters showed no significant change over 6 months.
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KEYWORD
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Pacemaker, Echocardiography, RV dysfunction, LV dysfunction
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