title: Dynamic and site-specific impact of ventricular pacing on left ventricular ejection fraction.
abstract: BACKGROUND
  Some studies suggest that right ventricular (RV) pacing has an adverse impact on left ventricular ejection fraction (LVEF), particularly in subjects with preexisting left ventricular (LV) dysfunction, and that direct LV pacing may be relatively protective. Interactions between pacing site and LVEF remain unclear.
  
  
  OBJECTIVE
  The purpose of this study was to examine the relative impact of RV and LV pacing on LVEF by serial study during a period in which LV dysfunction, induced by tachypacing, was introduced and then resolved.
  
  
  METHODS
  In each of five dogs, RV, LV, and simultaneous RV and LV (BiV) pacing modes were compared to native ventricular activation (1) prior to tachypacing (baseline), (2) weekly during a 5-week continuous tachypacing period, and (3) weekly during a 3-week post-tachypacing recovery period. At each evaluation, LVEF and LV contraction synchrony were assessed during each pacing mode.
  
  
  RESULTS
  The decrease in LVEF during the tachypacing period was more pronounced during RV pacing than during native activation or LV or BiV pacing. The magnitude of this effect correlated with a diminishment in LV contraction synchrony that was not observed during native activation or LV or BiV pacing. During the post-tachypacing period, gradual reversal of these changes toward baseline was observed.
  
  
  CONCLUSIONS
  Compared to native activation, RV pacing worsens LVEF in a manner proportional to the severity of preexisting LV dysfunction, attributable to reduced LV contraction synchrony. In comparison, both LV and BiV pacing preserve LVEF and contraction synchrony.
authors.affiliation: Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. schwartzmand@upmc.edu
authors.forename: David
authors.initials: D
authors.lastname: Schwartzman
authors.forename: Lauren
authors.initials: L
authors.lastname: Johnson
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Tanaka
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Ota
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
authors.forename: Bouchra
authors.initials: B
authors.lastname: Lamia
authors.forename: Michael R
authors.initials: MR
authors.lastname: Pinsky
authors.forename: Sanjeev G
authors.initials: SG
authors.lastname: Shroff
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D002304:Cardiac Pacing, Artificial; D004285:Dogs; D004562:Electrocardiography; D006325:Heart Atria / Q000473:pathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000294:innervation / Q000473:pathology*; D009200:Myocardial Contraction; D013223:Statistics as Topic; D013318:Stroke Volume; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology*; D016277:Ventricular Function, Left