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Cardiovascular: Basic ScienceBasic Science Posters |
1 Medicina Nucleare, Ospedale S.Maria della Misericordia, Rovigo, Italy; ; 2 Cardiologia, S Maria della Misericordia Rovigo Hospital, Rovigo, Italy
811
Objectives: To study intra-patient comparison of myocardial perfusion corresponding to right ventricular apical pacing RVAP vs direct His bundle pacing DHBP, as perfusion expresses local workload and is related to long-term outcome.
Methods: Twelve consecutive patients with standard pacemaker (PM) indication (9 M, 74 ± 9 yrs) entered the study. Pacing leads were implanted in the right ventricular apex and directly in the His bundle, and were connected to different ports of the PM. All patients first underwent 3 months of DHBP, followed by 3 months of RVAP. At the end of each 3-month period, myocardial perfusion was measured at rest using MIBI-SPECT. The average values of perfusion were evaluated on a 20-segment basis. Moreover, all patients also underwent clinical evaluation, echocardiography and Tissue Doppler Imaging (TDI), to measure dyssynchrony, and a blood sample was taken for BNP assay.
Results: The perfusion score during DHBP pacing was significantly better than during RVAP (0.44 ± 0.5 vs 0.71 ± 0.53, respectively, p=0.011); a good correlation was found between MIBI-SPECT and echocardiography. None of the patients showed lower perfusion during DHBP than during RVAP. We found no significant difference in NYHA class, ventricular volumes, ejection fraction or plasmatic BNP between DHBP and RVAP. However, mitral regurgitation (0.26 ± 0.21 vs. 0.37 ± 0.25; p<0.001) and dyssynchrony (13.75 ± 4.28 vs 22.02 ± 8.44 p=0.008) were significantly less during DHBP than during RVAP.
Conclusions: DHBP is superior to RVAP in preserving the physiologic distribution of myocardial blood flow and reducing mitral regurgitation and left ventricular dyssynchrony.
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