Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Nov 26, 2024; 16(11): 644-650
Published online Nov 26, 2024. doi: 10.4330/wjc.v16.i11.644
Impact of single chamber and dual chamber permanent pacemaker implantation on left ventricular function: An observational study
Merajul Haque, Monika Bhandari, Akshyaya Pradhan, Pravesh Vishwakarma, Abhishek Singh, Ayush Shukla, Akhil Sharma, Gaurav Chaudhary, Rishi Sethi, Sharad Chandra, Arvind Jaiswal, Sudhanshu Kumar Dwivedi
Merajul Haque, Department of Cardiology, BRD Medical College, Gorakhpur 273013, Uttar Pradesh, India
Monika Bhandari, Akshyaya Pradhan, Pravesh Vishwakarma, Abhishek Singh, Ayush Shukla, Akhil Sharma, Gaurav Chaudhary, Rishi Sethi, Sharad Chandra, Arvind Jaiswal, Sudhanshu Kumar Dwivedi, Department of Cardiology, King George’s Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Haque M performed a literature search, data acquisition, and experimental studies and prepared manuscript; Bhandari M conducted clinical studies, data analysis, and manuscript preparation; Pradhan A conducted the study and prepared the manuscript; Vishwakarma P contributed to study design, data acquisition, and manuscript preparation; Singh A led the concept, clinical studies, data analysis, and manuscript preparation; Shukla A conducted a literature search, performed analysis, and prepared the manuscript; Chaudhary G was involved in designing the concept, performing statistical analysis and review manuscript; Sethi R contributed to study design, data acquisition, and manuscript preparation; Chandra S conducted clinical studies, data analysis, and manuscript preparation; Jaiswal A led the concept, clinical studies, data analysis, and manuscript preparation; Dwivedi SK performed the study and did statistical analysis of the data. All authors approved the final draft and are accountable for the manuscript’s content.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of King George’s Medical University (ECM-II B-Theisis/P24).
Informed consent statement: Informed and written consent was taken from each subject as per institutional requirement.
Conflict-of-interest statement: All the Authors have no conflict of interest related to the manuscript.
Data sharing statement: Data is available with corresponding author and will be made available on reasonable request.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Monika Bhandari, MD, Professor, Department of Cardiology, King George’s Medical University, Shahmina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. drmonikab@gmail.com
Received: April 15, 2024
Revised: August 24, 2024
Accepted: September 6, 2024
Published online: November 26, 2024
Processing time: 199 Days and 1.4 Hours
Abstract
BACKGROUND

Permanent pacemaker implantation has the potential to impact left ventricular (LV) function and hence quality of life (QoL) in the long term.

AIM

To assess the effect of single- and dual-chamber pacing on LV function and QoL.

METHODS

This study included 56 patients who underwent permanent pacing: Dual pacing, dual sensing, dual responsive and rate responsive (DDDR) for the initial 3 months, ventricular sensing, inhibited response and rate responsive (VVIR) for the next 3 months, and DDDR mode for the last 3 months. Throughout the study period, various echocardiographic parameters, functional status, and QoL were measured to assess the impact of pacing on LV function compared with baseline and at every 3 months interval.

RESULTS

A significant change appeared in cardiac function after VVIR pacing which was in diastolic properties of LV as shown by increase in isovolumic relaxation time from (85.28 ± 9.54 ms) to (89.53 ± 9.65 ms). At the 3-, 6-, and 9-month follow-up, reduction in LV ejection fraction was observed to be 62.71 ± 4.66%, 61.07 ± 4.41%, and 58.48 ± 3.89%, respectively. An increase in the QoL scores was noted at every follow-up visit.

CONCLUSION

An apparent depressant effect on LV function due to right ventricular pacing, with a higher incidence of adverse outcomes in the VVIR mode. In addition, an upsurge in QoL scores for the study population was noted, which indicates improvement in the QoL of patients post-pacing, irrespective of the mode. Generally, the DDDR mode is a highly preferable pacing mode.

Keywords: Artificial pacemaker; Echocardiography; Left ventricular function; Quality of life

Core Tip: Pacemaker implantation is a common treatment for cardiac conduction disorders, but the impact of right ventricular pacing (RVP) on left ventricular (LV) function remains a concern. Limited information is available on the acute and early effects of RVP on LV function, particularly when comparing dual pacing, dual sensing, dual responsive and rate responsive (DDDR) and ventricular sensing, inhibited response and rate responsive (VVIR) pacemakers. This study found that RVP adversely affects LV function, with more significant impairment observed in VVIR mode compared to DDDR mode. However, both modes led to improvements in quality of life (QoL). The findings support the use of DDDR mode over VVIR mode for better clinical outcomes and preservation of LV function, while also improving QoL.