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Abstract
The purpose of this study was to investigate the effect of long-term ventricular pacing
on myocardial perfusion and function in patients receiving such pacing.
The long-term effect of ventricular pacing on myocardial perfusion and function in
humans is unclear, although animal studies have suggested that it may be adverse.
Forty-three patients with complete heart block and dual-chamber rate-adaptive (DDDR)
pacing were studied. All underwent thallium-201 (Tl-201) exercise myocardial scintigraphy
to assess myocardial perfusion and radionuclide ventriculography to determine left
ventricular function and regional wall motion. Coronary angiography was also performed
in patients with abnormal findings on Tl-201 study.
There was no significant difference in mean age, gender, percent ventricular pacing,
pacing threshold, ventricular pacing output and metabolic equivalents on exercise
testing between patients with or without perfusion defects on exercise Tl-201 scintigraphy.
However, the duration of pacing tended to be longer in patients with than in those
without perfusion defects (43.9 +/- 49.7 vs. 20.1 +/- 9.8 months, p = 0.05). Tl-201
perfusion defects were noted in 28 (65%) of 43 of patients (inferior 78% [n = 22],
apical 67% [n = 17], septal 21% [n = 6], anterior 7% [n = 2], lateral 3% [n = 1)].
Of 16 of 28 patients with abnormal Tl-201 findings who underwent coronary angiography,
only 3 (19%) had significant coronary artery disease. Patients with an abnormal perfusion
defect had a significantly lower left ventricular ejection fraction (48.5 +/- 9.9%
vs. 59.6 +/- 8.9%, p < 0.001) and a higher percent of wall motion abnormalities (57%
vs. 20%, p = 0.026), mainly over apical regions.
Long-term right ventricular apical pacing resulted in a high incidence of myocardial
perfusion defects that increased with the duration of pacing. These myocardial perfusion
abnormalities were associated with apical wall motion abnormalities and impaired global
left ventricular function.