title: Long-term effect of septal or apical pacing on left and right ventricular function after permanent pacemaker implantation.
abstract: BACKGROUND
  Right ventricular (RV) pacing is associated with left ventricular (LV) dysfunction. However, the effects of RV pacing at different sites on both LV and RV function have rarely been studied before. We want to determine whether different RV pacing sites differentially affect LV and RV deformation by using speckle tracking echocardiography (STE).
  
  
  METHODS
  The subjects were 73 patients who had undergone dual-chamber permanent pacemaker implantation and did not have structural heart diseases. LV and RV global longitudinal strains (GLS) were measured using STE to determine subtle changes in LV function. Twenty-three patients without pacing after pacemaker implantation served as controls; 14 and 36 patients showed apical and septal pacing, respectively.
  
  
  RESULTS
  There were no significant intergroup demographic differences. LV biplane ejection fractions in the septal- and apical-pacing groups were significantly lower than those in the controls. The GLS LV values were similar between the control and septal-pacing groups, but they were lower in the apical-pacing group. Multivariate analysis revealed that cumulative pacing loads and apical pacing were independent factors associated with lower GLS LV values. The GLS RV values were similar between the control and apical-pacing groups; however, they were lower in the septal-pacing group.
  
  
  CONCLUSIONS
  We concluded that patients with septal pacing have significantly higher GLS LV and more modest decreases in GLS RV values than patients with apical pacing. Thus, septal pacing may be not necessarily preferable in patients without significant heart disease undergoing dual-chamber permanent pacemaker implantation.
authors: Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
authors: Ju-Yi
authors: JY
authors: Chen
authors: Wei-Chuan
authors: WC
authors: Tsai
authors: Yen-Wen
authors: YW
authors: Liu
authors: Wen-Huang
authors: WH
authors: Li
authors: Yi-Heng
authors: YH
authors: Li
authors: Liang-Miin
authors: LM
authors: Tsai
authors: Li-Jen
authors: LJ
authors: Lin
mesh_terms: D000368:Aged; D054537:Atrioventricular Block / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D006325:Heart Atria; D006346:Heart Septum; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019919:Prosthesis Implantation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000517:prevention & control*; D013318:Stroke Volume; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000453:epidemiology*
keywords: apical pacing; global longitudinal strain; septal pacing