Bradycardia Clinical Trial
Official title:
The Effect of Right Ventricular Pacing on Myocardial Oxidative Metabolism and Efficiency
Right ventricular (RV) apical pacing induces a left bundle branch block (LBBB) type
electrical activation sequence in the heart. This abnormal activation pattern of the
ventricles may have detrimental effects on cardiac structure and function. RV pacing has
been shown to impair left ventricular (LV) function both in normal and failing hearts.
Importantly, it has been demonstrated that this deterioration in LV function is related to
the presence of LV dyssynchrony during RV pacing.
The exact effects of RV pacing on myocardial perfusion, oxidative metabolism and cardiac
efficiency have not been fully elucidated. The objective of the present study is to evaluate
the effect of RV pacing on both global and regional oxidative metabolism and perfusion, and
myocardial efficiency. In addition, the effect of RV pacing induced LV dyssynchrony on
myocardial oxidative metabolism and efficiency will be studied.
Our hypothesis is that LV dyssynchrony during RV pacing results in regional abnormalities in
LV perfusion and oxidative metabolism. LV dyssynchrony will also result in altered
myocardial efficiency.
Right ventricular (RV) apical pacing induces a left bundle branch block (LBBB) type
electrical activation sequence in the heart. This abnormal activation pattern of the
ventricles may have detrimental effects on cardiac structure and function. Several clinical
trials have demonstrated an association between RV pacing and an increased risk of heart
failure and death. In addition, RV pacing has been shown to impair left ventricular (LV)
function both in normal and failing hearts. Importantly, it has been demonstrated that this
deterioration in LV function is related to the presence of LV dyssynchrony during RV pacing.
The exact effects of RV pacing on myocardial perfusion, oxidative metabolism and cardiac
efficiency have not been fully elucidated. Importantly, the relation between the presence of
LV dyssynchrony during RV pacing and changes in myocardial perfusion, oxidative metabolism
and cardiac efficiency has not been studied.
Ten patients with normal LV ejection fraction and VVI/DDD pacemaker will be studied during
AAI-pacing/sinus rhythm without RV pacing (pacing-OFF) and with RV-pacing (pacing-ON) at the
same heart rate. Dynamic [15O]water and [11C]acetate positron emission tomography is used to
measure perfusion and oxidative metabolism (kmono) of the LV. An echocardiographic
examination is used to assess LV stroke volume (SV) and LV dyssynchrony.
The PET data will be first analyzed based on RV pacing mode only, comparing the two pacing
conditions (pacing-ON vs. pacing-OFF). Thereafter, the study population will be divided into
two groups, according to the presence of LV dyssynchrony during RV pacing.
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Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Single Blind (Investigator), Primary Purpose: Basic Science
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