title: Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing.
abstract: OBJECTIVE
  The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.
  
  
  BACKGROUND
  1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.
  
  
  METHODS
  Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference (delta) in QRS duration between apical and septal stimulation (deltaxyz) was correlated with the difference in phase distribution (deltaAuC) and ejection parameters (deltaEF, deltaEC).
  
  
  RESULTS
  QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (deltaxvz) and phase distribution (deltaAuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (deltaEF: r = 0.70931, p = 0.004; deltaEC: r = 0.74368, p = 0.002).
  
  
  CONCLUSIONS
  In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests.
authors.affiliation: Medizinische Klinik, Innere Medizin III, Universitätskliniken des Saarlandes, Homburg/Saar, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Schwaab
authors.forename: G
authors.initials: G
authors.lastname: Fröhlig
authors.forename: C
authors.initials: C
authors.lastname: Alexander
authors.forename: M
authors.initials: M
authors.lastname: Kindermann
authors.forename: N
authors.initials: N
authors.lastname: Hellwig
authors.forename: H
authors.initials: H
authors.lastname: Schwerdt
authors.forename: C M
authors.initials: CM
authors.lastname: Kirsch
authors.forename: H
authors.initials: H
authors.lastname: Schieffer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000503:physiopathology*; D006327:Heart Block / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011446:Prospective Studies; D015635:Radionuclide Ventriculography; D016896:Treatment Outcome; D016277:Ventricular Function, Left