Impacts of ventricular rate regularization pacing at right ventricular apical vs. septal sites on left ventricular function and exercise capacity in patients with permanent atrial fibrillation.
OBJECTIVE
The deleterious effects of right ventricular apex (RVA) pacing may offset the potential benefit of ventricular rate (VR) regularization during atrial fibrillation (AF). Recent studies suggested that right ventricular septal (RVS) pacing may prevent the potential deleterious effects of RVA pacing and enhance the VR regularization (VRR) with ventricular pacing due to closer proximity of the pacing site to the retrograde atrioventricular conduction.


RESULTS
We randomized 24 patients with permanent AF and symptomatic bradycardia to undergo RVA (n = 12) or RVS (n = 12) pacing. A VRR algorithm was programmed for all patients at 6-month after implantation. All patients underwent 6 min hall walk (6MHW) to assess exercise capacity at 6, 12, and 24 months, and radionuclide ventriculography to determine left ventricular ejection fraction (LVEF) at 6 and 24 months. Baseline characteristics were comparable in both groups except pacing QRS duration was significantly shorter during RVS pacing than RVA pacing (132 +/- 4 vs. 151 +/- 6 ms, P = 0.012). In both groups, VRR significantly increased the percentage of ventricular pacing and reduced VR variability (P < 0.05) without increasing mean VR (P > 0.05). At 6 months, 6MHW and LVEF were comparable in patients with RVA and RVS pacing (P > 0.05). At 24 months, patients with RVA pacing had significant decreases in LVEF and 6MHW after VRR pacing (P < 0.05), whereas RVS pacing with VRR preserved LVEF and improved 6MHW (P < 0.05).


CONCLUSIONS
In patients with permanent AF, VRR pacing at RVS, but not at RVA, preserves LVEF and provides incremental benefit for exercise capacity.
Tse
Hung-Fat
HF
Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People's Republic of China. hftse@hkucc.hku.hk
Wong
Kwong-Kuen
KK
Siu
Chung-Wah
CW
Tang
Man-Oi
MO
Tsang
Vella
V
Ho
Wai-Yin
WY
Lau
Chu-Pak
CP
D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D011877:Radionuclide Imaging; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*; D054088:Ventricular Septum / Q000000981:diagnostic imaging / Q000503:physiopathology*