Damia Pereferrer1,2,3, Axel Sarrias1,2,3, Raquel Adeliño1,2,3, Felipe Bisbal1,2,3, Júlia Aranyó1,2,3, Nuria Vallejo1,2,3, Roger Villuendas1,2,3, Antoni Bayes-Genis1,2,3, Victor Bazan4,5,6. 1. Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, s/n Carretera de Canyet, 08916, Barcelona, Spain. 2. CIBERCV, Madrid, Spain. 3. Universitat Autonoma de Barcelona, Barcelona, Spain. 4. Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, s/n Carretera de Canyet, 08916, Barcelona, Spain. victorbazang@yahoo.com. 5. CIBERCV, Madrid, Spain. victorbazang@yahoo.com. 6. Universitat Autonoma de Barcelona, Barcelona, Spain. victorbazang@yahoo.com.
Abstract
BACKGROUND: Adequate synchronization between the passive ("E") and active ("a") left ventricular (LV) diastolic filling contributes to the efficiency of the heartbeat. E/a superposition in dual-chamber pacemaker (PM) recipients is an under-recognized phenomenon that may be corrected by shortening the atrio-ventricular interval (AVI). We aimed at establishing the prevalence of E/a superposition in PM patients and to analyze the clinical, echocardiographic, and biological impact of AVI shortening. METHODS: Seventy patients with dual-chamber PMs (74 ± 8 years old, 12 women) were consecutively enrolled in this study. Patients with baseline E/a superposition were crossed over from default to manually shortened AVI or vice versa in a case-control fashion (intervention group). Patients without baseline E/a superposition (controls) served as a reference for a descriptive comparison with the intervention group. RESULTS: Thirty-three patients had E/a superposition after PM implantation (47%). Controls (n = 37) had higher LV ejection fraction (59 ± 8% vs. 53 ± 10%, p = 0.048) and lower levels of high sensitive troponin T and ST2 (p < 0.05) than intervention group patients. The AVI was shortened at 48 ± 9 ms in order to ensure adequate E/a separation. The walked distance increased from 75 ± 17 to 78 ± 10% (p = 0.049) and the Euro-QoL score from 0.50 ± 0.27 to 0.63 ± 0.19 (p = 0.011) with short AVI. CONCLUSIONS: E/a superposition occurs in approximately half of dual-chamber PM recipients and is associated with reduced LV function and increased myocardial injury biomarkers. AVI shortening produces a modest but significant effect in functional capacity and quality of life.
BACKGROUND: Adequate synchronization between the passive ("E") and active ("a") left ventricular (LV) diastolic filling contributes to the efficiency of the heartbeat. E/a superposition in dual-chamber pacemaker (PM) recipients is an under-recognized phenomenon that may be corrected by shortening the atrio-ventricular interval (AVI). We aimed at establishing the prevalence of E/a superposition in PM patients and to analyze the clinical, echocardiographic, and biological impact of AVI shortening. METHODS: Seventy patients with dual-chamber PMs (74 ± 8 years old, 12 women) were consecutively enrolled in this study. Patients with baseline E/a superposition were crossed over from default to manually shortened AVI or vice versa in a case-control fashion (intervention group). Patients without baseline E/a superposition (controls) served as a reference for a descriptive comparison with the intervention group. RESULTS: Thirty-three patients had E/a superposition after PM implantation (47%). Controls (n = 37) had higher LV ejection fraction (59 ± 8% vs. 53 ± 10%, p = 0.048) and lower levels of high sensitive troponin T and ST2 (p < 0.05) than intervention group patients. The AVI was shortened at 48 ± 9 ms in order to ensure adequate E/a separation. The walked distance increased from 75 ± 17 to 78 ± 10% (p = 0.049) and the Euro-QoL score from 0.50 ± 0.27 to 0.63 ± 0.19 (p = 0.011) with short AVI. CONCLUSIONS: E/a superposition occurs in approximately half of dual-chamber PM recipients and is associated with reduced LV function and increased myocardial injury biomarkers. AVI shortening produces a modest but significant effect in functional capacity and quality of life.
Authors: Josep Brugada; Peter Paul Delnoy; Johannes Brachmann; Dwight Reynolds; Luigi Padeletti; Georg Noelker; Charan Kantipudi; José Manuel Rubin Lopez; Wolfgang Dichtl; Alberto Borri-Brunetto; Luc Verhees; Philippe Ritter; Jagmeet P Singh Journal: Eur Heart J Date: 2017-03-07 Impact factor: 29.983