title: Right ventricular pacing from the septum avoids the acute exacerbation in left ventricular dyssynchrony and torsional behavior seen with pacing from the apex.
abstract: 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.
authors: Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon, Japan.
authors: Katsuji
authors: K
authors: Inoue
authors: Hideki
authors: H
authors: Okayama
authors: Kazuhisa
authors: K
authors: Nishimura
authors: Akiyoshi
authors: A
authors: Ogimoto
authors: Tomoaki
authors: T
authors: Ohtsuka
authors: Makoto
authors: M
authors: Saito
authors: Go
authors: G
authors: Hiasa
authors: Toyofumi
authors: T
authors: Yoshii
authors: Takumi
authors: T
authors: Sumimoto
authors: Junichi
authors: J
authors: Funada
authors: Jitsuo
authors: J
authors: Higaki
mesh_terms: 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*