Srikumar, S (2013) Evaluation of the interventricular systolic relationship in patients with right ventricular apical pacing with ventricular inhibited pacing mode by echocardiography using mitral and tricuspid annular plane systolic excursions. Masters thesis, Madras Medical College, Chennai.
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Abstract
The right (RV) and left (LV) ventricles differ markedly in shape and myocardial contractile element density. Despite these differences, the synchronous electrical excitation and mechanical contraction of both the ventricles and the ventricular interdependence maintains the biventricular function in balance 13. This is known as ventricular synchrony. Certain disease states like ischemic heart disease (IHD), acute pulmonary embolism, conduction disorders like left bundle branch block (LBBB), preexcitation, and ventricular pacing alters this balance resulting in ventricular dyssynchrony. RV apical permanent pacemaker implantation (PPI) with ventricular inhibited pacing (VVI) mode is known to produce ventricular dyssynchrony by abnormal electrical and mechanical activation of the ventricles. Long-term RV apical pacing is also associated with detrimental effects on cardiac structure and left ventricular (LV) function15. Echocardiographic evaluation of LV and RV systolic function by measuring mitral annular plane systolic excursion (MAPSE) 8 and tricuspid annular plane systolic excursion (TAPSE)9 and their ratio (MAPSE/TAPSE ratio)12 has been shown to correlate with ventricular synchrony in normal healthy individuals. M-mode echocardiographic evaluation of MAPSE, TAPSE, and their ratio can provide information regarding the degree of ventricular dyssynchrony in patients with VVI pacing. AIMS AND OBJECTIVES: 1. To assess the systolic function of left and right ventricle by mitral and tricuspid annular plane systolic excursions in patients with VVI pacing. 2. To analyse the interventricular systolic relationship using MAPSE/TAPSE ratio in patients with VVI pacemaker implantation. CONCLUSIONS: 1. Chronic VVI pacing from RV apex is associated with varying degrees of LV and RV dysfunction. 2. The degree of prolongation of the paced QRS duration is a powerful determinant of worsening ventricular function. 3. Advanced age is associated with both a marked prolongation of the paced QRS duration and progressive ventricular dysfunction in patients with VVI pacing. 4. MAPSE and TAPSE are useful parameters for quickly assessing LV and RV functions in VVI pacing. 5. LVEF and MAPSE/TAPSE ratio have linear correlation for LV dysfunction in VVI pacing. 6. MAPSE/TAPSE ratio is a novel indicator of ventricular dysfunction and lower levels are suggestive of associated interventricular dyssynchrony. However, this ratio needs further validation by larger randomized studies.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Interventricular systolic ; right ventricular apical pacing ; ventricular inhibited pacing mode ; echocardiography ; mitral ; tricuspid ;annular plane ; systolic ; excursions. |
| Subjects: | MEDICAL > Cardiology |
| Depositing User: | Kambaraman B |
| Date Deposited: | 04 Jul 2017 10:15 |
| Last Modified: | 04 Jul 2017 10:15 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/906 |
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