Thrombosis of prosthetic heart valves: diagnosis and therapeutic considerations.
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Echocardiography, Transesophageal↗
Biomedical subjects
Raymond Roudaut
Publications and source records attributed to Raymond Roudaut.
Cardiac hemangioma presenting as atypical chest pain.
A 44-year-old man presented with atypical chest pain and dyspnea. Investigation revealed the presence of a 15-mm rounded, well-vascularized left-ventricular mass. The mass was removed surgically and histopathologic evaluation identified a cardiac hemangioma.
Adult↗
Effects of right, left, and biventricular pacing on myocardial perfusion in ischemic conditions.
OBJECTIVES: In normal hearts, the distribution of regional myocardial perfusion is altered by ventricular pacing. Little is known about the impact of ventricular pacing on regional myocardial perfusion in ischemic conditions. In this acute echocardiographic study, we compared the respective effects of right ventricular pacing (RVP), left ventricular pacing (LVP), and biventricular pacing (BVP) on regional perfusion in a swine model of graded ischemia. METHODS AND RESULTS: Ventricular pacing leads were placed at the apex of the right ventricle and on the lateral wall of the left ventricle in nine open-chest pigs. Myocardial contrast echocardiography was successively performed during spontaneous rhythm (SR), RVP, LVP, and BVP in random order at baseline and during three stages of incremental ischemia (left anterior descending + circumflex). At baseline, RVP decreased myocardial perfusion of the septal and inferior walls compared to SR (P < 0.05), whereas LVP decreased perfusion of the lateral wall (P < 0.05). No significant differences were observed in regional perfusion during BVP compared to SR. In ischemic conditions, RVP worsened myocardial perfusion in the ischemic anterior wall as well as in the septal and inferior walls (P < 0.05), whereas both LVP and BVP did not alter perfusion in the ischemic area compared to SR. CONCLUSION: Compared to baseline, in ischemic conditions, RVP has a more pronounced detrimental impact on perfusion abnormalities. In contrast, BVP induced a significant improvement in local myocardial perfusion. Therefore, BVP could be preferred to RVP in patients with ischemic cardiomyopathy.
Animals↗
Dynamic ventricular dyssynchrony: an exercise-echocardiography study.
OBJECTIVES: We sought to assess the effects of exercise on ventricular dyssynchrony in patients with normal and depressed left ventricular (LV) function. BACKGROUND: Asynchronous myocardial contraction adversely influences ventricular function and is associated with a poor prognosis in heart failure. Exercise-induced changes in ventricular dyssynchrony may be an important determinant of dynamic changes in cardiac output and mitral regurgitation. METHODS: A total of 65 consecutive heart failure patients and 50 matched healthy control patients underwent exercise echocardiography. Conventional and tissue Doppler parameters were measured before and during symptom-limited exercise. Left ventricular dyssynchrony was defined as the standard deviation of 12 LV segmental electromechanical delays. Analysis of the control group allowed delimitation of normal cutoff values. RESULTS: In patients with normal left ventricular function, exercise did not modify the extent of LV asynchrony. In contrast, in heart failure patients, LV dyssynchrony increased by at least 20% in 34%, remained stable in 37%, and decreased by at least 20% in 29%. Moreover, 26% of heart failure patients had either exercise induction or normalization of ventricular dyssynchrony. A significant association was found between exercise-induced changes in dyssynchrony and the presence of ischemic cardiomyopathy (p < 0.05). Rest-exercise differences in ventricular dyssynchrony were correlated with changes in cardiac output and mitral regurgitation (r = -0.63 and 0.56, respectively). CONCLUSIONS: In heart failure patients, exercise can alter the magnitude of ventricular dyssynchrony. Some patients have a response to exertion with induction of ventricular dyssynchrony, whereas others show normalization. Changes in ventricular dyssynchrony during exercise correlate with alterations in cardiac output and mitral regurgitation.
Aged↗
Echocardiographic assessment during exercise of heart failure patients with cardiac resynchronization therapy.
This prospective echocardiographic study investigated the respective impacts of left ventricular (LV) pacing and simultaneous and sequential biventricular pacing (BVP) on ventricular dyssynchrony during exercise in 23 patients with compensated heart failure and ventricular conduction delays. During exercise, LV pacing and BVP significantly (p <0.05) improved mitral regurgitation and LV dyssynchrony compared with spontaneous activation. LV segmental electromechanical delays were significantly prolonged during LV pacing, leading to increased systolic time (p <0.05), decreased LV filling time (p <0.05), and decreased stroke volume (p <0.05) compared with BVP. After optimization of the interventricular delay with sequential BVP, additional benefit was obtained during exercise in terms of stroke volume and mitral regurgitation (p <0.05). The optimal interventricular delay was different at rest and during exercise in 57% of the patients. Changes from at rest to exercise in LV dyssynchrony were correlated with changes in stroke volume (r = -0.61, p <0.01) and changes in mitral regurgitation (r = 0.60, p <0.01).
Cardiac Pacing, Artificial↗
Predictive value of noninvasive coronary angiography with multidetector computed tomography to detect significant coronary stenosis before valve surgery.
Quantitative coronary angiography (QCA) is routinely performed before valve surgery for severe acquired valvular disease. This technique is relatively invasive, especially in a population with an average risk for significant coronary stenosis. Multidetector computed tomography (MDCT) coronary angiography allows the noninvasive evaluation of the coronary anatomy. The aim of this prospective study was to evaluate the predictive values of 16-slice MDCT in the detection of significant coronary stenosis (> or = 50%) before valve surgery in patients with severe valvular disease without known coronary artery disease and average risk, in comparison with conventional QCA. Forty patients with severe acquired valvular disease (mean age 70 +/- 8.6 years; 20 women; 27 with severe aortic stenosis) underwent coronary MDCT 2 days before cardiac catheterization with QCA. The mean heart rate was 64.7 +/- 8.8 beats/min (range 41 to 78). Four hundred fifty-eight of 600 coronary artery segments (77.3%) were considered assessable by MDCT. In a per-segment analysis, the sensitivity of MDCT for the detection of significant coronary lesions > or = 50% was 77.7%, the specificity was 98%, the positive predictive value was 42.4%, and the negative predictive value was 99%. The main cause of false-positive or false-negative results or nonassessable evaluations was severe coronary calcification. In a per-patient analysis, in comparison with QCA, MDCT correctly classified 33 of 40 patients (82.5%). In conclusion, in patients with an average risk for coronary stenosis before valve surgery, MDCT coronary angiography detected significant obstructive coronary artery disease, with a 99% NPV.
Aged↗
Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy.
OBJECTIVES: Recently, a novel method to measure strain from standard two-dimensional images has been developed. Our goal was to characterize global and regional systolic function abnormalities using this technique in patients with hypertrophic cardiomyopathy (HCM). BACKGROUND: Strain has been proposed as a sensitive tool to detect early systolic function abnormalities in HCM. However, the clinical application of conventional Doppler-derived strain has been limited by poor reproducibility and angle dependency. METHODS: Echocardiographic examinations were performed in 26 patients with nonobstructive HCM and 45 healthy subjects. Using a dedicated software package, bidimensional acquisitions were analyzed to measure longitudinal and transverse strain in apical views and circumferential and radial strain in parasternal short-axis view. RESULTS: Despite apparently normal left ventricular systolic function, all components of strain were significantly reduced in HCM. Average longitudinal, transverse, circumferential, and radial strain in patients with HCM and controls were -15.1 +/- 6.2% versus -20.3 +/- 5.6%, 23.3 +/- 17.0% versus 27.2 +/- 14.9%, -16.8 +/- 7.1% versus 19.6 +/- 5.2%, and 25.2 +/- 13.9% versus 36.8 +/- 17.2%, respectively (all p < 0.001). In patients with asymmetrical HCM, longitudinal septal strain was significantly lower than for other left ventricular segments combined: -9.2 +/- 4.7% versus -12.7 +/- 7.1% (p = 0.001). Average interobserver and intraobserver variabilities were 11% and 11.3%, respectively. CONCLUSIONS: Two-dimensional strain is a new simple, rapid, and reproducible method to measure different components of systolic strain. This technique identified early abnormalities in patients with HCM that have apparently normal left ventricular systolic function.
Cardiomyopathy, Hypertrophic↗
Localized sources maintaining atrial fibrillation organized by prior ablation.
BACKGROUND: Endocardial mapping of localized sources driving atrial fibrillation (AF) in humans has not been reported. METHODS AND RESULTS: Fifty patients with AF organized by prior pulmonary vein and linear ablation were studied. AF was considered organized if mapping during AF showed irregular but discrete atrial complexes exhibiting consistent activation sequences for >75% of the time using a 20-pole catheter with 5 radiating spines covering 3.5-cm diameter or sequential conventional mapping. A site or region centrifugally activating the remaining atrial tissue defined a source. During AF with a cycle length of 211+/-32 ms, activation mapping identified 1 to 3 sources at the origin of atrial wavefronts in 38 patients (76%) predominantly in the left atrium, including the coronary sinus region. Electrograms at the earliest area varied from discrete centrifugal activation to an activity spanning 75% to 100% of the cycle length in 42% of cases, the latter indicating complex local conduction or a reentrant circuit. A gradient of cycle length (>20 ms) to the surrounding atrium was observed in 28%. Local radiofrequency ablation prolonged AF cycle length by 28+/-22 ms and either terminated AF or changed activation sequence to another organized rhythm. In 4 patients, the driving source was isolated, surrounded by the atrium in sinus rhythm, and still firing at high frequency (228+/-31 ms) either permanently or in bursts. CONCLUSIONS: AF associated with consistent atrial activation sequences after prior ablation emanates mostly from localized sources that can be mapped and ablated. Some sources harbor electrograms suggesting the presence of localized reentry.
Aged↗
[Follow-up of patients with artificial cardiac valves and vascular prostheses. First part--monitoring patients with artificial valves].
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Follow-Up Studies↗
Absolute assessment of aortic valve stenosis by planimetry using cardiovascular magnetic resonance imaging: comparison with transesophageal echocardiography, transthoracic echocardiography, and cardiac catheterisation.
OBJECTIVE: The aims of this study were to investigate absolute assessment of aortic valve area (AVA), before surgery for aortic stenosis, using cardiovascular magnetic resonance (CMR) in comparison with transesophageal echocardiography (TEE) and with effective AVA indirectly obtained by routine techniques i.e. transthoracic echocardiography (TTE) and cardiac catheterisation. MATERIALS AND METHODS: Absolute AVA planimetry was performed by TEE and CMR steady state free precession sequences obtained through the aortic valvular plane. Effective AVA was calculated by the continuity equation in TTE and by cardiac catheterisation (Gorlin formula). RESULTS: Thirty-nine patients with aortic valve stenosis, mean age 71.7 +/- 7.6 years, with a mean AVA of 0.93 +/- 0.31 cm2 as measured by TEE, were enrolled in the study. Mean differences were: between CMR and TEE planimetry: d = 0.01 +/- 0.14 cm2, between CMR and cardiac catheterisation: d = 0.05 +/- 0.13 cm2, between CMR and TTE: d = 0.10 +/- 0.17 cm2, between TTE and TEE: d = 0.10 +/- 0.18 cm2, between TTE and cardiac catheterisation: d = 0.06 +/- 0.16 cm2, and between TEE and cardiac catheterisation: d = 0.07 +/- 0.13 cm2. Mean intraobserver and interobserver differences of CMR planimetry were d = 0.02 +/- 0.07 cm2 and d = 0.03 +/- 0.14 cm2, respectively. CONCLUSION: CMR planimetry of the AVA is a noninvasive and reproducible technique to evaluate stenotic aortic valves and can be used as an alternative to echocardiography or cardiac catheterisation.
Aged↗
[Is early stent thrombosis an inflammatory disease? A study of 1306 implantations].
The authors tried to determine the clinical characteristics and predisposing factors of early stent thrombosis (EST) through the study of 15 patients who had had angiographically diagnosed stent thrombosis within 30 days of the implantation of the stent. The cases were compared to 29 control random patients collected between January 1, 2000 and August 31, 2001. Out of the 1306 patients who had been given coronary stents, 20 of them (1.5%) had an OO.. EST, representing 1.3 per patient. The patients, 12 males and 3 females, had a mean age of 62 + 10.3 years ranging between 46 and 77 years. EST occurred within 7.4 + 3.8 days (2 hours n 29 days) on average, in the left anterior descending branch (10 cases), in the right coronary artery (6cases) or in the left circumflex (3 cases) and finally in the postero-lateral branch (1 case). Stent recanalisation was performed within 3.4 + 2 hours (1-7 hours) on average. In spite of prompt revascularization, the problem progressed to MI in all cases and to subsequent death in 3 cases (20%). Procedure related variables of emergency PTCA, dissection, anatomical type B or C coronary lesions, related WBC count and C- reactive protein were significantly associated with EST while remained a rare event following PTCA. The incidence is low but the prognosis is still poor in spite of early intervention. Other studies are needed to confirm the probable inflammatory nature of this complication.
Aged↗
Significant improvement of myocardial function following cardiac support device implantation: illustration by two-dimensional strain.
Cardiac support devices (CSD) offer a new therapeutic alternative to patients with end-stage refractory heart failure and severe left ventricle (LV) dilatation. Passive mechanical constraint has been shown to reduce LV dilatation as well as to improve LV function and patient symptoms. Using a new echocardiographic technique to evaluate myocardial strain from bidimensional acquisitions, we describe the case of a patient with significant improvement in global and regional LV functions, as well as LV dyssynchrony following CSD implantation.
Echocardiography↗
Reverse remodeling of the left cardiac chambers after catheter ablation after 1 year in a series of patients with isolated atrial fibrillation.
BACKGROUND: Isolated atrial fibrillation (AF) is associated with mild enlargement of the left atrium (LA) and left ventricular (LV) diastolic dysfunction. The impact of ablation of isolated AF on left chamber size and function is unclear, and whether diastolic dysfunction is the cause or the consequence of AF remains unknown. The objective of this prospective study was to evaluate the impact of sinus rhythm restoration by catheter ablation on LV diastolic dysfunction, LA morphology, and mechanical function. METHODS AND RESULTS: Forty-eight patients with isolated AF were studied by serial echocardiographic studies at baseline and at 1-, 3-, 6-, 9-, and 12-month intervals after radiofrequency ablation. LA dimensions and mechanical function and LV systolic and diastolic functions were evaluated at each time interval. Diastolic function was assessed with conventional Doppler parameters and new indexes such as tissue Doppler imaging, mitral flow propagation velocity, and combined criteria. LV diastolic dysfunction was present in paroxysmal and chronic AF patients with a reduction of tissue Doppler imaging lateral early diastolic peak velocity in 37% (P<0.001) and 48% (P<0.01), respectively, compared with healthy control subjects. At the end of the follow-up, LA area decreased significantly by 18% (P<0.001) in paroxysmal and 23% (P<0.05) in chronic AF patients. Diastolic function improved significantly with an increase in lateral early diastolic peak velocity of 29% (P<0.001) in paroxysmal AF and 46% (P<0.05) in chronic AF patients. A significant increase in LV ejection fraction was also noted for both groups: 7.7% and 18.8%, respectively. CONCLUSIONS: This study demonstrates reverse morphological remodeling of the LA and improvement of LV diastolic and systolic functions after restoration of sinus rhythm by ablation for isolated AF. Because patients with isolated AF have none of the traditional causes of LV diastolic dysfunction, our findings suggest that AF may be partly the cause rather than the consequence of diastolic dysfunction.
Adult↗
Quantitative analysis of myocardial perfusion in rats by contrast echocardiography.
BACKGROUND: The ability to assess myocardial perfusion in small animals is important, especially to investigate models of myocardial ischemia. Myocardial perfusion is usually assessed by postmortem techniques, eliminating the possibility of follow-up. We sought to evaluate whether contrast echocardiography was able to quantify myocardial perfusion in rats. METHODS: Twenty-four rats divided in 3 groups (sham-operated, and 8 and 21 days after left anterior descending coronary artery stenosis) underwent myocardial contrast echocardiography using intermittent triggered imaging. Peak plateau intensity and slope of refilling were compared with myocardial blood flow achieved with fluorescent microspheres. RESULTS: High-quality images were easily obtained for each experiment. Close correlation was found between myocardial contrast echocardiography and myocardial blood flow, especially for measurements of peak plateau intensity x slope of refilling relative to the control area (y = 1.15 x -0.14, r = 0.86). CONCLUSION: Quantification of myocardial perfusion in rats is feasible by myocardial contrast echocardiography using intermittent triggered imaging.
Animals↗
Catheter ablation of long-lasting persistent atrial fibrillation: critical structures for termination.
BACKGROUND: The relative contributions of different atrial regions to the maintenance of persistent atrial fibrillation (AF) are not known. METHODS: Sixty patients (53 +/- 9 years) undergoing catheter ablation of persistent AF (17 +/- 27 months) were studied. Ablation was performed in a randomized sequence at different left atrial (LA) regions and comprised isolation of the pulmonary veins (PV), isolation of other thoracic veins, and atrial tissue ablation targeting all regions with rapid or heterogeneous activation or guided by activation mapping. Finally, linear ablation at the roof and mitral isthmus was performed if sinus rhythm was not restored after addressing the above-mentioned areas. The impact of ablation was evaluated by the effect on the fibrillatory cycle length in the coronary sinus and appendages at each step. Activation mapping and entrainment maneuvers were used to define the mechanisms and locations of intermediate focal or macroreentrant atrial tachycardias. RESULTS: AF terminated in 52 patients (87%), directly to sinus rhythm in 7 or via the ablation of 1-6 intermediate atrial tachycardias (total 87) in 45 patients. This conversion was preceded by prolongation of fibrillatory cycle length by 39 +/- 9 msec, with the greatest magnitude occurring during ablation at the anterior LA, coronary sinus and PV-LA junction. Thirty-eight atrial tachycardias were focal (originating dominantly from these same sites), while 49 were macroreentrant (involving the mitral or cavotricuspid isthmus or LA roof). Patients without AF termination displayed shorter fibrillatory cycles at baseline: 130 +/- 14 vs 156 +/- 23 msec; P = 0.002. CONCLUSION: Termination of persistent AF can be achieved in 87% of patients by catheter ablation. Ablation of the structures annexed to the left atrium-the left atrial appendage, coronary sinus, and PVs-have the greatest impact on the prolongation of AF cycle length, the conversion of AF to atrial tachycardia, and the termination of focal atrial tachycardias.
Atrial Fibrillation↗
Catheter ablation of long-lasting persistent atrial fibrillation: clinical outcome and mechanisms of subsequent arrhythmias.
BACKGROUND: Catheter ablation of atrial fibrillation (AF) is challenging in patients with long-standing persistent AF. The clinical outcome and subsequent arrhythmia recurrence after using an ablation method targeting multiple left atrial sites with the aim of achieving acute AF termination has not been characterized. METHODS: Sixty patients (mean age: 53 +/- 9 years) with persistent AF (mean duration: 17 +/- 27 months) were prospectively followed after catheter ablation. Catheter ablation targeting the following sites was performed in a random sequence: (i) electrical isolation of all pulmonary veins (PV); (ii) disconnection of other thoracic veins; (iii) atrial ablation at sites possessing complex electrical activity, activation gradients, or short cycle lengths. Finally, linear ablation of the LA roof and mitral isthmus was performed if sinus rhythm was not restored following energy delivery to the above sites. At 1, 3, 6, and 12 months after ablation, patients underwent clinical review and 24-hour ambulatory ECG monitoring to identify asymptomatic arrhythmia. Repeat mapping and catheter ablation was performed in any patient experiencing recurrent atrial tachycardia (AT). Clinical success was defined as the absence of any sustained atrial arrhythmia. RESULTS: AF terminated during ablation in 52 patients (87%). The fluoroscopy and procedural durations were 84 +/- 30 minutes and 264 +/- 77 minutes, respectively. Three months after ablation, sustained ATs were documented in 24 patients (associated with AF in 2). Mapping in 23 patients showed a single AT in 7 while multiple ATs were observed in 16. Macroreentry was confirmed to be due to gaps in the ablation lines, while focal ATs originated from discrete sites or isthmuses near the left atrial appendage, coronary sinus, pulmonary veins, or fossa ovalis; these sites were similar to those at which the greatest impact was observed on the fibrillatory process during the initial ablation procedure. After repeat ablation, at 11 +/- 6 months of follow-up, 57 patients (95%) were in sinus rhythm and 3 developed recurrent AF or AT. All patients in sinus rhythm demonstrated improved exercise capacity and all but 2 had evidence of atrial transport as assessed by Doppler echocardiography (mitral A wave velocity 34 +/- 17 cm/sec) by 6 months. CONCLUSION: Catheter ablation of long-lasting persistent AF associated with acute AF termination achieves medium to long-term restoration and maintenance of sinus rhythm in 95% of patients. Arrhythmia recurrence in the majority of patients is AT.
Adult↗
Echocardiographic parameters of ventricular dyssynchrony validation in patients with heart failure using sequential biventricular pacing.
OBJECTIVES: We sought to evaluate the relationship between hemodynamic and ventricular dyssynchrony parameters in patients undergoing simultaneous and sequential biventricular pacing (BVP). BACKGROUND: Various echocardiographic parameters of ventricular dyssynchrony have been proposed to screen and optimize BVP therapy. METHODS: Forty-one patients with heart failure undergoing BVP implantation were studied. Echocardiography coupled with tissue tracking and pulsed Doppler tissue imaging (DTI) was performed before and after BVP implantation and after three months of optimized BVP. Indexes of inter- or intraventricular dyssynchrony were correlated with hemodynamic changes during simultaneous and sequential BVP (10 intervals of right ventricular [RV] or left ventricular [LV] pre-excitation). RESULTS: Variations in intra-LV delay(peak), intra-LV delay(onset), and index of LV dyssynchrony measured by pulsed DTI were highly correlated with those of cardiac output (r = -0.67, r = -0.64, and r = -0.67, respectively; p < 0.001) and mitral regurgitation (r = 0.68, r = 0.63, and r = 0.68, respectively; p < 0.001), whereas variations in the extent of myocardium displaying delayed longitudinal contraction (r = -0.48 and r = 0.51, respectively; p < 0.05) and the variations in septal-to-posterior wall motion delay (r = -0.41, p < 0.05 and r = 0.24, p = NS, respectively) were less correlated. The changes in interventricular dyssynchrony were not significantly correlated (p = NS). Compared with simultaneous BVP, individually optimized sequential BVP significantly increased cardiac output (p < 0.01), decreased mitral regurgitation (p < 0.05), and improved all parameters of intra-LV dyssynchrony (p < 0.01). At three months, a significant reverse mechanical LV remodeling was observed with significantly decreased LV volumes (p < 0.01) associated with an increased LV ejection fraction (p = 0.035). CONCLUSIONS: Specific echocardiographic measurements of ventricular dyssynchrony are highly correlated with hemodynamic changes and may be a useful adjunct in the selection and optimization of BVP. Individually optimized sequential BVP provided a significant early hemodynamic improvement compared with simultaneous BVP.
Aged↗
Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing.
BACKGROUND: Although dual-chamber pacing improves cardiac function in patients with complete congenital atrioventricular block (CCAVB) by restoring physiological heart rate and atrioventricular synchronization, the long-term detrimental effect of asynchronous electromechanical activation induced by apical right ventricular pacing (RVP) has not been well clarified. METHODS AND RESULTS: Twenty-three CCAVB adults (24+/-3 years) with a DDD transvenous pacemaker underwent conventional echocardiography before implantation and, after at least 5 years of RVP, an exercise test and echocardiography coupled with tissue Doppler imaging and tissue tracking. They were compared with 30 matched healthy control subjects. After 10+/-3 years of RVP, CCAVB adults had significantly higher values versus controls in terms of intra-left ventricular (LV) asynchrony (respectively, 59+/-18 versus 19+/-9 ms, P<0.001), extent of LV myocardium displaying delayed longitudinal contraction (39+/-15% versus 10+/-7%, P<0.01), and septal-to-posterior wall-motion delay (84+/-26 versus 18+/-9 ms, P<0.01). The ratio of late-activated posterior to early-activated septal wall thickness was higher after long-term RVP than before (1.3+/-0.2 vs 1+/-0.1, P=0.05) and was higher than in controls (1+/-0.1, P<0.05). The percentage of patients with increased LV end-diastolic diameter was higher after long-term RVP than before implantation and was higher than in controls (57% versus 13%, P<0.05, and 57% versus 0%, P<0.01, respectively). CCAVB patients with long-term RVP had a lower cardiac output than controls (3.8+/-0.6 versus 4.9+/-0.8 L/min, P<0.05) and lower exercise performance (123+/-24 versus 185+/-39 W, P<0.001). CONCLUSIONS: Prolonged ventricular dyssynchrony induced by long-term endovenous RVP is associated with deleterious LV remodeling, LV dilatation, LV asymmetrical hypertrophy, and low exercise capacity. These new data highlight the importance of the ventricular activation sequence in all patients with chronic ventricular pacing.
Adult↗