Document Detail


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.
MedLine Citation:
PMID:  19363054     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: 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. METHODS AND 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). CONCLUSION: In patients with permanent AF, VRR pacing at RVS, but not at RVA, preserves LVEF and provides incremental benefit for exercise capacity.
Authors:
Hung-Fat Tse; Kwong-Kuen Wong; Chung-Wah Siu; Man-Oi Tang; Vella Tsang; Wai-Yin Ho; Chu-Pak Lau
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2009-04-10
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  11     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-29     Completed Date:  2009-06-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  594-600     Citation Subset:  IM    
Affiliation:
Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, People's Republic of China. hftse@hkucc.hku.hk
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Algorithms
Atrial Fibrillation / physiopathology*,  therapy*
Exercise Tolerance / physiology*
Female
Heart Ventricles / physiopathology*,  radionuclide imaging
Humans
Male
Middle Aged
Pacemaker, Artificial*
Prospective Studies
Stroke Volume / physiology
Ventricular Dysfunction, Left / physiopathology
Ventricular Dysfunction, Right / physiopathology
Ventricular Function, Left / physiology*
Ventricular Septum / physiopathology*,  radionuclide imaging

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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