Novel Imaging Modalities To Evaluate The Complications Of Cardiac Pacing

Abstract

Heart failure and infection are recognised complications of cardiac pacing. Rightventricular (RV) pacing is established to have detrimental effects on myocardial functionand is associated with a broad spectrum of left ventricular dysfunction, from mild pacinginducedventricular dysfunction (PIVD) to more severe manifestations such as pacinginducedcardiomyopathy (PICMP) and heart failure in patients with preserved myocardialfunction at the index implantation. In view of this consideration, there is a clear need for astrategy to identify a priori patients who are likely to develop PIVD with identification ofpre-symptomatic LV dysfunction which can be targeted by upgrade to biventricular pacingto prevent progression of LV dysfunction. Infection is another recognised complication ofcardiac implantable electronic device (CIED) implantation. Early diagnosis of infection isessential in order to avoid spread of infection and late-infective complications. In thisthesis we examined the clinical utility of two different non-invasive imaging modalities for(i) the detection of pacing-induced ventricular dysfunction (PIVD) and (ii) the earlydiagnosis of CIED infection.In a prospective observational study of pacemaker recipients with high-gradeatrioventricular block and preserved baseline left ventricular ejection fraction (LVEF>55%), one-month global longitudinal strain (GLS) was significantly reduced in patientswho would subsequently develop PIVD and PICMP. Further analysis indicated that a onemonthGLS of

Date of Award	1 Aug 2016
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Delvac Oceandy (Supervisor) & Mamas Mamas (Supervisor)