Document Detail


Right ventricular outflow pacing induces less regional wall motion abnormalities in the left ventricle compared with apical pacing.
MedLine Citation:
PMID:  21946819     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: This study aimed to explore if the right ventricular outflow tract (RVOT) pacing is superior to right ventricular apical (RVA) pacing on the overall left ventricular (LV) function and regional wall motion.
METHODS AND RESULTS: Sixty patients with atrio-ventricular (AV) block and normal ejection fraction undergoing dual-chamber pacemaker implantation were randomized to permanent ventricular stimulation either in the RVOT or the RVA. Left ventricular volume, ejection fraction, and LV regional wall motion were assessed by echocardiography. Right ventricular apical pacing had prolonged QRS duration, compared with RVOT pacing (154.1 ± 26.5 vs. 120.9 ± 22.3, P< 0.05). There were also significant differences in LV pre-ejection interval and interventricular mechanical delay (IVMD) at 12-month follow-up between the two groups, but none in the LV volume, left ventricular ejection fraction, and index of systolic synchrony (Ts-SD). During RVA pacing, the average peak systolic velocity (Sm) of 12 LV segments [3.5, 95% confidence interval (CI) 3.2-3.8 cm/s] had a trend of being lower compared with RVOT pacing (3.9, 95% CI 3.5-4.1 cm/s) (P= 0.09). Further analysis showed that the Sm at the inferior wall and posterior-septum wall was significantly decreased during RVA pacing compared with RVOT pacing. There were no significant differences for other LV segments.
CONCLUSION: The RVOT pacing in AV block patients over 1 year may be superior to RVA pacing in terms of regional LV performance, LV global electromechanical delay, and IVMD, although intraventricular dyssynchrony and LV volumes do not differ. Larger trials with clinical endpoints are warranted to conclusively define the advantages of RVOT or RV septal pacing.
Authors:
Fang Wang; Haoying Shi; Yaping Sun; Jufang Wang; Qing Yan; Wei Jin; Jianjun Zhang; Weidong Meng; Feng Zhang; Gang Chen; Baogui Sun
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2011-09-22
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:  14     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-22     Completed Date:  2012-07-11     Revised Date:  2012-10-23    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  England    
Other Details:
Languages:  eng     Pagination:  351-7     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Shanghai Jiao Tong University-Affiliated First People's Hospital, Shanghai 200080, China.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Atrioventricular Block / therapy*
Cardiac Pacing, Artificial / methods*
Electrocardiography
Female
Humans
Male
Middle Aged
Stroke Volume / physiology
Treatment Outcome
Ventricular Dysfunction, Left / physiopathology,  therapy*,  ultrasonography
Comments/Corrections
Comment In:
Europace. 2012 Sep;14(9):1376; author reply 1376-7   [PMID:  22547764 ]

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


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