ECHO report

So last week I had an ECHO to determine my heart function to determine whether I could start my antiarrhythmic at home. Nothing was really very surprising to me with the results (I have come to just expect the worst now a days). One thing that did catch me off that I have not heard before was states "left ventricular systolic function is low end of normal with ejection fraction of 50-55% with paradoxical septal motion from pacing." What exactly is paradoxical septal motion????

6 Comments

PSM

by lenora - 2009-11-13 05:11:23

Paroxysmal septal motion is movement of the septum of the heart toward the right rather than to the left during systole (contraction). Sometimes it occurs after heart surgery such as valve replacement when the cardiopulmonary bypass machine was used. In your case it apparently means the pacemaker itself is causing the shift. Your LVSF looks okay and the EF is not too bad in spite of it.

normal?

by sam78 - 2009-11-13 05:11:37

so then is that normal for someone that is 100% ventricly paced?

paradoxical septal motion

by sam78 - 2009-11-14 03:11:00

I understand about the EF, that is not what I had the question about.... I was more interested in the paradoxical septal motion. Is that what happens when you are paced in the ventricle?

Normal EF

by ElectricFrank - 2009-11-14 12:11:07

According to the Mayo site normal EF is 55-70%, but I've seen other figures near that range. With numbers like yours the important thing is to track their direction.

frank

thanks... but

by sam78 - 2009-11-14 12:11:26

thanks CABG.. but that doesnt really answer my question.

paradoxical septal motion with pacing

by ElectricFrank - 2009-11-15 01:11:44

Sorry I missed your question. Your post was very clear about it.

I have a general idea of what is happening in paradoxical septal motion from pacing, but I'm far from an expert at it. The contraction of the ventricles under normal conditions starts from a pacing stimulus entering them via the left and right bundles. Our hearts come from the factory with the timing of these signals together with the location of the bundles optimized to give the best activity of the two chambers including the shared septum.

When a pacemaker is installed to substitute for this finely tuned machine we are stuck with the stimulus being applied to only one chamber and at a location determined by where the surgeon can attach a lead. (the exception to this is with the newer 3 lead pacers where the venticles can be paced separately).

So the result is that a stimulus is applied somewhere on the wall of the right ventricle and the resulting contraction spreads across to the left ventricle area. The right ventricle will contract first moving the septum one way, followed my the left ventricle contraction moving it the other. I don't totally understand the intricate timing of this, but it seems that the pacemaker would cause it to be different than in the naturally paced heart. A paradoxical motion would imply that it is the reverse of what would be expected in the normal heart.

So having confused myself, I'll post this. If anyone has better information or sees that I'm wrong in my assumptions, feel free to let us know.

best,

frank

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