Long-term mechanical consequences of permanent right ventricular pacing: Effect of pacing site

Darryl Leong, Anne Mitchell, Ingrid Salna, Anthony Brooks, Gautam Sharma, Han Lim, Muayad Alasady, Malcolm Barlow, J Leitch, Prashanthan Sanders, Glenn Young

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    Abstract

    Optimal Right Ventricular Pacing Introduction: Long-term right ventricular apical (RVA) pacing has been associated with adverse effects on left ventricular systolic function; however, the comparative effects of right ventricular outflow tract (RVOT) pacing are unknown. Our aim was therefore to examine the long-term effects of septal RVOT versus RVA pacing on left ventricular and atrial structure and function. Methods: Fifty-eight patients who were prospectively randomized to long-term pacing either from the right ventricular apex or RVOT septum were studied echocardiographically. Left ventricular (LV) and atrial (LA) volumes were measured. LV 2D strain and tissue velocity images were analyzed to measure 18-segment time-to-peak longitudinal systolic strain and 12-segment time-to-peak systolic tissue velocity. Intra-LV synchrony was assessed by their respective standard deviations. Interventricular mechanical delay was measured as the difference in time-to-onset of systolic flow in the RVOT and LV outflow tract. Septal A' was measured using tissue velocity images. Results: Following 29 ± 10 months pacing, there was a significant difference in LV ejection fraction (P < 0.001), LV end-systolic volume (P = 0.007), and LA volume (P = 0.02) favoring the RVOT-paced group over the RVA-paced patients. RVA-pacing was associated with greater interventricular mechanical dyssynchrony and intra-LV dyssynchrony than RVOT-pacing. Septal A' was adversely affected by intra-LV dyssynchrony (P < 0.05). Conclusions: Long-term RVOT-pacing was associated with superior indices of LV structure and function compared with RVA-pacing, and was associated with less adverse LA remodeling. If pacing cannot be avoided, the RVOT septum may be the preferred site for right ventricular pacing. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1120-1126)

    Original languageEnglish
    Pages (from-to)1120-1126
    Number of pages7
    JournalJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY
    Volume21
    Issue number10
    DOIs
    Publication statusPublished - Oct 2010

    Keywords

    • Doppler echocardiography
    • LV function
    • pacemaker
    • ventricular dyssynchrony tissue

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    Leong, D., Mitchell, A., Salna, I., Brooks, A., Sharma, G., Lim, H., Alasady, M., Barlow, M., Leitch, J., Sanders, P., & Young, G. (2010). Long-term mechanical consequences of permanent right ventricular pacing: Effect of pacing site. JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, 21(10), 1120-1126. https://doi.org/10.1111/j.1540-8167.2010.01804.x