Right ventricular pacing from the septum avoids the acute exacerbation in left ventricular dyssynchrony and torsional behavior seen with pacing from the apex.
OBJECTIVE
The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing.


METHODS
Forty-six patients with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes.


RESULTS
Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate.


CONCLUSIONS
In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing.
Inoue
Katsuji
K
Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon, Japan.
Okayama
Hideki
H
Nishimura
Kazuhisa
K
Ogimoto
Akiyoshi
A
Ohtsuka
Tomoaki
T
Saito
Makoto
M
Hiasa
Go
G
Yoshii
Toyofumi
T
Sumimoto
Takumi
T
Funada
Junichi
J
Higaki
Jitsuo
J
D000208:Acute Disease; D000368:Aged; D001919:Bradycardia / Q000150:complications / Q000000981:diagnostic imaging / Q000517:prevention & control; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods*; D004452:Echocardiography / Q000379:methods; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D014102:Torsion Abnormality / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control*