title: Long-term nonoutflow septal versus apical right ventricular pacing: relation to left ventricular dyssynchrony.
abstract: 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.
authors.affiliation: Second Department of Cardiology, Attikon University Hospital, Athens, Greece. pflevari@yahoo.com
authors.forename: Panayota
authors.initials: P
authors.lastname: Flevari
authors.forename: Dionyssios
authors.initials: D
authors.lastname: Leftheriotis
authors.forename: Katerina
authors.initials: K
authors.lastname: Fountoulaki
authors.forename: Fotis
authors.initials: F
authors.lastname: Panou
authors.forename: Angelos G
authors.initials: AG
authors.lastname: Rigopoulos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.forename: Dimitrios Th
authors.initials: DT
authors.lastname: Kremastinos
mesh_terms: 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*