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Do advanced echocardiographic measurements give insight into who develops pacing-induced cardiac dysfunction?


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Key facts

Type of research degree
4 year PhD
Application deadline
Ongoing deadline
Country eligibility
International (outside UK)
Additional supervisors
Maria Paton and Klaus Witte
School of Medicine
Research groups/institutes
Leeds Institute of Medical Research at St James's
<h2 class="heading hide-accessible">Summary</h2>

Summary: Around 40% of patients implanted with a pacemaker to treat bradycardia have or develop cardiac dysfunction (Gierula et al., 2015). Currently we have particularly limited insight into which patients are at high risk of adverse cardiac remodeling and impairment. Some clinical characteristics have been associated previously, such as known ischaemic heart disease and presence of atrial fibrillation (Gierula et al., 2015, Begg et al., 2011), however, we still cannot predict who&amp;rsquo;s cardiac function will deteriorate prior to implant. If we could, we could be able to potentially implant a more sophisticated cardiac device, such as cardiac resynchronization therapy, or implant via the His bundle in these patients so as to avoid right ventricular pacing entirely. Currently, it is too expensive to provide every patient with these alternate methods of pacemaker therapy, and clinical trials have not shown a benefit in doing so, likely because of the heterogenous response to right ventricular pacing (Curtis et al., 2007).<br /> <br /> We aim to use advanced echocardiographic imaging techniques, which are now becoming routinely available, although rarely utilised, in clinical practice. We have shown changes in these measures in patients with forced right ventricular pacing compared to during episodes of their own intrinsic rhythm. We believe particularly strain measures and myocardial work may provide subclinical information and have predictive power for this patient cohort in terms of cardiac deterioration.

<h2 class="heading hide-accessible">Full description</h2>

<p><strong>References</strong></p> <p>BEGG, G., GIERULA, J., WALDRON, Z. &amp; WITTE, K. 2011. 154 Patients receiving standard pacemaker generator replacements frequently have impaired left ventricular function and exercise intolerance, related to the percentage of right ventricular pacing.&nbsp;<em>Heart,</em>&nbsp;97<strong>,</strong>&nbsp;A86-A86.</p> <p>CURTIS, A. B., ADAMSON, P. B., CHUNG, E., JOHN SUTTON, M. S., TANG, F. &amp; WORLEY, S. 2007. Biventricular versus right ventricular pacing in patients with AV block (BLOCK HF): clinical study design and rationale.&nbsp;<em>Journal of cardiovascular electrophysiology,</em>&nbsp;18<strong>,</strong>&nbsp;965-971.</p> <p>GIERULA, J., CUBBON, R. M., JAMIL, H. A., BYROM, R. J., WALDRON, Z. L., PAVITT, S., KEARNEY, M. T. &amp; WITTE, K. K. 2015. Patients with long-term permanent pacemakers have a high prevalence of left ventricular dysfunction.&nbsp;<em>Journal of Cardiovascular Medicine,</em>&nbsp;16<strong>,</strong>&nbsp;743-750.</p>

<h2 class="heading">How to apply</h2>

<p>Please note these are not standalone projects and applicants must apply to the PhD academy directly.</p> <p>Applications can be made at any time. To apply for this project applicants should complete a<a href=""> Faculty Application Form</a> and send this alongside a full academic CV, degree transcripts (or marks so far if still studying) and degree certificates to the Faculty Graduate School <a href=""></a></p> <p>We also require 2 academic references to support your application. Please ask your referees to send these <a href="">references</a> on your behalf, directly to <a href=""></a></p> <p>If you have already applied for other projects using the Faculty Application Form this academic session you do not need to complete this form again. Instead you should email fmhgrad to inform us you would like to be considered for this project.</p> <p>If English is not your first language, you must provide evidence that you meet the University&#39;s minimum English language requirements (below).</p> <p><em>We welcome applications from all suitably-qualified candidates, but UK black and minority ethnic (BME) researchers are currently under-represented in our Postgraduate Research community, and we would therefore particularly encourage applications from UK BME candidates. All scholarships will be awarded on the basis of merit.</em></p>

<h2 class="heading heading--sm">Entry requirements</h2>

A degree in biological sciences, dentistry, medicine, midwifery, nursing, psychology or a good honours degree in a subject relevant to the research topic. A Masters degree in a relevant subject may also be required in some areas of the Faculty. For entry requirements for all other research degrees we offer, please contact us.

<h2 class="heading heading--sm">English language requirements</h2>

Applicants whose first language is not English must provide evidence that their English language is sufficient to meet the specific demands of their study. The Faculty of Medicine and Health minimum requirements in IELTS and TOEFL tests for PhD, MSc, MPhil, MD are: &acirc;&euro;&cent; British Council IELTS - score of 7.0 overall, with no element less than 6.5 &acirc;&euro;&cent; TOEFL iBT - overall score of 100 with the listening and reading element no less than 22, writing element no less than 23 and the speaking element no less than 24.

<h2 class="heading">Contact details</h2>

<p>For further information please contact the Graduate School Office<br /> e:&nbsp;<a href=""></a>, t: +44 (0)113 343 8221.</p>

<h3 class="heading heading--sm">Linked research areas</h3>