Long-term nonoutflow septal versus apical right ventricular pacing: relation to left ventricular dyssynchrony.
BACKGROUND
Right ventricular (RV) apical pacing deteriorates left ventricular (LV) function. RV nonoutflow (low) septal pacing may better preserve ventricular performance, but this has not been systematically tested. Our aim was to assess (1) whether long-term RV lower septal pacing is superior to RV apical pacing regarding LV volumes and ejection fraction (EF), and (2) if the changes in LV dyssynchrony imposed by pacing are related to the long-term changes in LV volumes and EF.


METHODS
In thirty-six patients with atrioventricular (AV) block, a dual-chamber pacemaker was implanted. The ventricular electrode was placed either at the apex or at the lower septum, in a randomized sequence. Twenty-four to 48 hours following implantation, we measured LV volumes, EF, and LV dyssynchrony (by tissue Doppler imaging), both with and without pacing. Patients were reassessed echocardiographically after 12 months.


RESULTS
Lower septal pacing induced a more synchronized pattern of LV contraction changes (P < 0.05). Following 12 months, differences were observed between groups regarding LV volumes and EF. EF increased within the septal group (from 52 +/- 3.3% to 59 +/- 3.0%, P < 0.05). A significant inverse relation was documented between changes in LV dyssynchrony and changes in EF (r =-0.64, P < 0.05).


CONCLUSIONS
In patients with AV block, RV nonoutflow septal pacing represents an attractive alternative, since it preserves better and may even improve LV volumes and EF. Late changes in EF are associated with the changes in LV dyssynchrony imposed by pacing.
Flevari
Panayota
P
Second Department of Cardiology, Attikon University Hospital, Athens, Greece. pflevari@yahoo.com
Leftheriotis
Dionyssios
D
Fountoulaki
Katerina
K
Panou
Fotis
F
Rigopoulos
Angelos G
AG
Paraskevaidis
Ioannis
I
Kremastinos
Dimitrios Th
DT
D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000517:prevention & control*; D014694:Ventricular Outflow Obstruction / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*