The effect of right ventricular pacemaker lead position on functional status in patients with preserved left ventricular ejection fraction/Efekat polozaja pejsmejker elektrode u desnoj komori na funkcionalni status pacijenata sa ocuvanom ejekcionom frakcijom leve komore

• Published in: Medicinski pregled Vol. 69; no. 7-8; p. 212
• Main Authors: Mitov, Vladimir M, Perisic, Zoran, Jolic, Aleksandar, Kostic, Tomislav, Aleksic, Aleksandar, Aleksic, Zeljka
• Format: Journal Article
• Language: English
• Published: Drustvo Lekara Vojvodine 01.07.2016
• Subjects: Analysis; Care and treatment; Left heart ventricle; Methods; Right heart ventricle; Treatment outcome; Walking; Minnesota
• ISSN: 0025-8105
• DOI: 10.2298/MPNS1608212M

Introduction. The study was aimed at assessing the difference between the right ventricle apex versus the right ventricular outflow tract lead position in functional capacity in the patients with the preserved left ventricular ejection fraction after 12 months of pacemaker stimulation. Material and Methods. This was a prospective, randomized, follow-up study, which lasted for 12 months. The study sample included 132 consecutive patients who were implanted with permanent anti-bradicardiac pacemaker. Regarding the right ventricular lead position the patients were divided into two groups: the right ventricle apex group consisting of 61 patients with right ventricular apex lead position. The right ventricular outflow tract group included 71 patients with right ventricular outflow tract lead position. Functional capacity was assessed by Minnesota Living With Heart Failure score, New York Heart Association class and Six Minute Walk Test. Left ventricular ejection fraction was assessed by echocardiography. Results. Minnesota Living With Heart Failure score and New York Heart Association class had a statistically significant improvement in both study groups. The patients from right ventricle apex group walked 20.95% (p=0.03) more in comparison to starting values. The patients from right ventricular outflow tract group walked only 13.63% (p=0.09) longer distance than the starting one. Conclusion. Analysis of tests of functional status New York Heart Association class and Minnesota Living With Heart Failure questionnaire showed an even improvement in the right ventricle apex and right ventricular outflow tract groups. Analysis of 6 minute walk test showed that only the patients with the preserved left ventricular ejection fraction from the right ventricle apex group had a significant improvement after 12 months of pacemaker stimulation.. Key words: Pacemaker, Artificial; Electrodes, Implanted; Heart Ventricles; Ventricular Function, Left; Stroke Volume; Questionnaires; Walking; Bradycardia; Treatment Outcome Uvod. Cilj istrazivanja je procena uticaja stimulacije pejsmejkerom iz vrha desne komore (Right Ventricle Apex) i izlaznog trakta (Right Ventricle Outflow Tract) desne komore, nakon 12 meseci stimulacije pejsmejkerom, na funkcionalni status pacijenata sa ocuvanom ejekcionom frakcijom leve komore. Materijal i metode. Sprovedena je prospektivna, randomizovana studija pracenja u trajanju od 12 meseci. Istrazivanjem su obuhvacena 132 pacijenta kod kojih je implantiran permanentni antibradikardni pejsmejker. U odnosu na polozaj komorske elektrode, pacijenti su podeljeni u dve grupe: prva grupa--61 pacijent sa elektrodom pozicioniranom u vrhu desne komore; druga grupa--71 pacijent sa elektrodom pozicioniranom u izlaznom traktu desne komore. Funkcionalni status pacijenata procenjivan je preko upitnika Minnesota Living With Heart Failure i odredivanjem vrednosti skora, odredivanjem pripadnosti New York Heart Association klasi, kao i sestominutnim testom hodanja. Ejekciona frakcija leve komore procenjivana je ehokardiografskim pregledom. Rezultati. Vrednosti Minnesota Living With Heart Failure skora i New York Heart Association klase imali su statisticki znacajno poboljsanje u obe pracene grupe pacijenata. U prvoj grupi pacijenti su pelazili 20,95% (p = 0,03) duze distance u odnosu na pocetne vrednosti. U drugoj grupi pacijenti su pelazili samo 13,63% (p = 0,09) duze distance u odnosu na pocetne vrednosti. Zakljucak. Testovi za procenu funkcionalnog statusa, New York Heart Association klasa i Minnesota Living With Heart Failure upitnik, pokazali su podjednako poboljsanje u obe grupe. Analizom rezultata sestominutnog testa hodanja dobijeno je da je statisticki znacajno funkcionalno poboljsanje imali samo pacijenti iz prve grupe, nakon 12 meseci stimulacije pejsmejkerom, kod pacijentata sa ocuvanom ejekcionom frakcijom leve komore. Kljucne reci: pejsmejker; implantacija elektroda; srcane komore; funkcija leve komore srca; udarni volumen; upitnici; setanje; bradikardija; ishod lecenja