Schizophrenia in later life: Emerging from the shadows

摘要

in this issue of the Journal, Kim et al.1 report on the acute effects of right ventricular (RV) apical pacing on left ventricular (LV) synchrony and function and left atrial dynamics and filling pressures in patients with preserved LV ejection fraction (EF) needing chronic ventricular pacing. Pacing-induced LV dyssynchrony resulted in reduced mitral Em velocity indicating impaired LV relaxation and reduced LV strain suggesting reduced myocardial contractile performance despite absence of a change in LVEF or volume. This combined LV systolic and diastolic dysfunction seems to have resulted in a rise in left atrial pressure and perhaps secondary changes in left atrial mechanics. The implications of these findings are profound, given increasing number of pacemaker implants that are occurring globally and especially in elderly patients with sinus node disease who may need chronic ventricular pacing. In 2009, about a million pacemakers were implanted worldwide, a quarter of them in United States alone where the prevalence of pacemaker has approached 1 in 1000.