Affiliation:
1. Department of Cardiology Capa Istanbul Faculty of Medicine Istanbul University Istanbul Turkey
2. Department of Cardiology Acibadem University, School of Medicine Istanbul Turkey
3. Department of Cardiology Hammersmith Hospital Imperial College NHS Trust London United Kingdom
Abstract
Background
The extent of pressure‐related damage might be related to acceleration rate of the applied pressure (peak
dP
/dt) in the vascular system. In this study, we sought to determine whether
dP
/dt applied to the aortic wall (aortic
dP
/dt) and in turn vascular extracellular matrix degradation can be mitigated via modulation of left ventricular (
LV
) contractility (
LV dP
/dt) by pacemaker‐mediated desynchronization.
Methods and Results
First, in 34 patients, changes in aortic
dP
/dt values in 3 aortic segments in response to pacemaker‐mediated stepwise
QRS
widening leading to gradual desynchronization of the
LV
contraction by means of steadily changed atrioventricular delay (
AVD
) with temporary dual‐chamber pacing was examined before and after beta‐blocker (15 mg
IV
metoprolol) administration. Second, serum matrix metalloproteinase‐9 levels were measured in the 20 patients with permanent pacemaker while they were on sinus rhythm with normal
QRS
width and 3 weeks after wide
QRS
rhythm ensured by dual pacing, dual sensing, and dual response to sensing with short
AVD
.
LV dP
/dt substantially correlated with
dP
/dt measured in ascending (
r
=0.83), descending (
r
=0.89), and abdominal aorta (
r
=0.96).
QRS
width strongly correlated with
dP
/dt measured in ascending (
r
=−0.95), descending (
r
=−0.92), and abdominal (
r
=−0.96) aortic segments as well. In patients with permanent pacemaker, wide
QRS
rhythm led to a significant reduction in serum matrix metalloproteinase‐9 levels (from 142.5±32.9 pg/mL to 87.5±32.4 pg/mL [
P
<0.001]) at the end of 3 weeks follow‐up.
Conclusions
QRS
prolongation by short
AVD
dual pacing, dual sensing, and dual response to sensing results in concomitant decreases in peak
dP
/dt values in the
LV
and in all aortic segments with or without background beta‐blocker administration, which in turn led to a significant reduction in circulating matrix metalloproteinase‐9 levels.
Registration
URL
:
https://www.clinicaltrials.gov
; Unique identifier:
NCT
03665558.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
1 articles.
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