Title : 3d echocardiographic assessment of post pacemaker right ventricle dysfunction
Abstract:
Introduction:
Several studies have shown that unfavourable ventricular remodelling, mechanical dyssynchrony, and altered regional perfusion are all caused by the right ventricular (RV) pacing leading over time to development of Left Ventricular dysfunction. Nevertheless, the impact of Right Ventricular pacing on Right Ventricle function has not been thoroughly assessed. With this background a prospective study was done to assess the occurrence of Right Ventricle function by 2D and three-dimensional (3D) echocardiography at 3 months & 6 months after pacemaker implantation
Aims & Objectives:
To assess the Right Ventricle dimensions and Right Ventricle function at 3 months & 6 months after pacemaker implantation by echocardiography (including 3D echocardiography)
Materials & Methods:
This study was a prospective, descriptive, & single-centre study. All patients who underwent pacemaker implantation were assessed for RV function by 2D and 3D Echocardiography at baseline (pre-procedure), 3 months & 6 months after pacemaker implantation. The change in the follow-up period was evaluated by using single factor analysis of variance ANOVA with repeated measures in normally distributed data & Bonferroni post-hoc test. A p value of <0.05 is considered to be statistically significant.
Results:
From January 2022 to December 2022, a total of 66 patients with permanent pacemaker were enrolled in the study. There was statistically non- significant changes in mean LVEF (%) during follow up (62.13 ± 3.92 (Baseline ) vs. 62.21 ± 4.15 (3-month) vs 62.03 + 3.83 (6-months) , p value>0.05).However, there was statistically significant changes in mean PASP (mm Hg) during follow up (18.45 ± 3.45 (Baseline) vs. 22.18 ± 3.76 (3-month) vs 26.45 + 3.97 , p value <0.05).Also, there was statistically significant changes in mean RIMP during follow up ( 0.48 ± 0.04 (Baseline) vs. 0.50 ± 0.04 (3-month) vs 0.50 + 0.03 (6-month) , p value <0.05).Likewise, there was statistically significant changes in mean RV E/E’ during follow up ( 4.47 ± 0.57 (Baseline ) vs. 4.70 ± 0.74 (3-month) vs 4.95 + 0.82 (6-month) , p value <0.05).In addition, there was statistically significant changes in mean TR Jet Area (cm2) during follow up ( 1.68 ± 0.26 (Baseline) vs. 2.22 ± 0.43 (3-month) vs 2.56 + 0.53 (6-month), p value <0.05).But, there was statistically non-significant changes in mean RVEF % (3D Echo) during follow up ( 53.51 ± 2.75 (Baseline) vs. 53.02 ± 2.64 (3-month) vs 53.48 + 2.34 (6-month) , p value >0.05).Other echocardiographic parameters of RV function did not show any change in 3-months & 6-months follow-up.
Conclusion:
- There is change in Right Ventricular function after Pacemaker implantation which can be documented as early as 6 months post implantation.
- Permanent pacemaker was associated with changes in RIMP, RV E/E’, PASP, TR JET AREA during 6 months after ventricular pacing.
Audience Take Away:
- Based on our findings, it may be stated that there are significant changes documented in RIMP, RV E/E’, PASP, TR JET AREA during 6 months after ventricular pacing
- This study shows that patients with permanent pacemaker may derive significant benefit by early detection of changes in their RV function with echocardiography
- The present findings may help to further determine which right ventricle function parameters will change after permanent pacemaker implantation, and which parameters might not change
- Even though patient selection for permanent pacemaker may not be altered by knowledge of pre- implantation right ventricle function, it may help to place the individual patient in the appropriate part of the monitoring spectrum and aid in setting of expectations
- The findings of this study suggest that permanent pacemaker in addition to its known effects regarding LV function and remodeling and symptomatic and functional status also may change right ventricle function
