Right ventricular pacing from the septum avoids the acute exacerbation in left ventricular dyssynchrony and torsional behavior seen with pacing from the apex

Katsuji Inoue; Hideki Okayama; Kazuhisa Nishimura; Akiyoshi Ogimoto; Tomoaki Ohtsuka; Makoto Saito; Go Hiasa; Toyofumi Yoshii; Takumi Sumimoto; Junichi Funada; Jitsuo Higaki

doi:10.1016/j.echo.2009.10.015

Right ventricular pacing from the septum avoids the acute exacerbation in left ventricular dyssynchrony and torsional behavior seen with pacing from the apex

J Am Soc Echocardiogr. 2010 Feb;23(2):195-200. doi: 10.1016/j.echo.2009.10.015. Epub 2009 Dec 3.

Authors

Katsuji Inoue¹, Hideki Okayama, Kazuhisa Nishimura, Akiyoshi Ogimoto, Tomoaki Ohtsuka, Makoto Saito, Go Hiasa, Toyofumi Yoshii, Takumi Sumimoto, Junichi Funada, Jitsuo Higaki

Affiliation

¹ Division of Cardiology, Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine, Toon, Japan.

PMID: 19962275
DOI: 10.1016/j.echo.2009.10.015

Abstract

Objective: The study objective was to compare the left ventricular (LV) dyssynchrony and torsional behavior between right ventricular apical (RVA) and right ventricular septal (RVS) pacing.

Methods: Forty-six patients with symptomatic sick sinus syndrome and preserved LV function were assigned to 2 groups: RVA (n = 23) and RVS (n = 23). Echocardiographic study including two-dimensional speckle tracking imaging was performed in the AAI and DDD modes.

Results: Mean QRS width during DDD mode was significantly longer with RVA pacing than with RVS pacing. Dyssynchrony, torsion, and untwisting rate during DDD mode were significantly worse with RVA than with RVS pacing. In patients with RVA pacing, there was an increase in longitudinal dyssynchrony from AAI to DDD mode that significantly correlated with the deterioration of untwisting rate.

Conclusion: In bradyarrhythmic patients with preserved LV function, RVS pacing resulted in a reduced LV dyssynchrony and better torsional behavior than RVA pacing.

Publication types

Controlled Clinical Trial

MeSH terms

Acute Disease
Aged
Bradycardia / complications
Bradycardia / diagnostic imaging
Bradycardia / prevention & control
Cardiac Pacing, Artificial / adverse effects*
Cardiac Pacing, Artificial / methods*
Echocardiography / methods
Elasticity Imaging Techniques / methods
Female
Heart Septum / diagnostic imaging*
Heart Ventricles / diagnostic imaging*
Humans
Male
Torsion Abnormality / diagnostic imaging
Torsion Abnormality / etiology*
Torsion Abnormality / prevention & control*
Treatment Outcome
Ventricular Dysfunction, Left / diagnostic imaging
Ventricular Dysfunction, Left / etiology*
Ventricular Dysfunction, Left / prevention & control*