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The Korean Journal of Medicine 2010;78(1): 59-67.
인공 심박동기 환자에서 심실동기이상의 관련인자
김성수, 조정관, 김현국, 장수영, 심두선, 윤남식, 윤현주, 홍영준, 박형욱, 김주한, 안영근, 정명호, 박종춘, 강정채
The factors influencing ventricular dyssynchrony in patients with permanent pacemaker
Sung Soo Kim, Jeong Gwan Cho, Hyun Kuk Kim, Soo Young Jang, Doo Sun Sim, Nam Sik Yoon, Hyun Ju Yoon, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Young Keun Ahn, Myung Ho Jeong, Jong Chun Park, Jung Chaee Kang
ABSTRACT
Background/Aims:
Chronic right ventricular pacing (RVP) can lead to increased risks of ventricular dyssynchrony (VD), heart failure, and mortality. This study examined the factors influencing VD in patients treated with a permanent pacemaker (PPM).
Methods:
The study enrolled 139 patients (M:F=1:1.35, 66.8±1.0 years) who had permanent pacemaker implanted [AAI (R): 11, VVI (R): 39, VDD (R): 50, DDD: 39]. Their clinical characteristics, 12-lead electrocardiogram (ECG), echocardiography, and laboratory parameters were evaluated. The patients were divided into two groups according to the presence of VD.
Results:
VD was seen in 71.9% of the patients with a PPM. No significant difference was observed in the clinical characteristics, except for the indications and current action mode of the PPM. VD was more frequently associated with patients with AV block and ventricular pacing. The QRS duration and QTc interval were significantly wider in patients with VD (159.9±3.2 vs. 129.4±6.3 ms, p<0.001; 487.7±4.0 vs. 470.9±8.0 ms, p<0.05, respectively). On echocardiography, tricuspid regurgitation was more common in patients with VD. The N-terminal B-type natriuretic peptide (NT-proBNP) level was higher in the dyssynchrony group (431.4±66.1 vs. 202.8±40.8, p<0.05).
Conclusions:
Patients with AV block and ventricular pacing developed VD more frequently. A higher serum NT-proBNP level and prolonged QRS duration, QTc, and tricuspid regurgitation might be associated with VD. (Korean J Med 78:59-67, 2010)
Keywords: Pacemaker; ECG; Echocardiography
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