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J Am Coll Cardiol. 2002 Oct 16;40(8):1451-8.

Functional abnormalities in patients with permanent right ventricular pacing: the effect of sites of electrical stimulation.

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1
Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, China. hftse@hkucc.hku.hk

Abstract

OBJECTIVES:

We sought to evaluate the long-term effects of alternative right ventricular pacing sites on myocardial function and perfusion.

BACKGROUND:

Previous studies have demonstrated that asynchronous ventricular activation due to right ventricular apical (RVA) pacing alters regional myocardial perfusion and functions.

METHODS:

We randomized 24 patients with complete atrioventricular block to undergo permanent ventricular stimulation either at the RVA (n = 12) or right ventricular outflow (RVOT) (n = 12). All patients underwent dipyridamole thallium myocardial scintigraphy and radionuclide ventriculography at 6 and 18 months after pacemaker implantation.

RESULTS:

After pacing, the mean QRS duration was significantly longer during RVA pacing than during RVOT pacing (151 +/- 6 vs. 134 +/- 4 ms, p = 0.03). At six months, the incidence of myocardial perfusion defects (50% vs. 25%) and regional wall motion abnormalities (42% vs. 25%) and the left ventricular ejection fraction (LVEF) (55 +/- 3% vs. 55 +/- 1%) were similar during RVA pacing and RVOT pacing (p > 0.05). However, at 18 months, the incidence of myocardial perfusion defects (83% vs. 33%) and regional wall motion abnormalities (75% vs. 33%) were higher and LVEF (47 +/- 3 vs. 56 +/- 1%) was lower during RVA pacing than during RVOT pacing (all p < 0.05). Patients with RVA pacing had a significant increase in the incidence of myocardial perfusion defects (p < 0.05) and a decrease in LVEF (p < 0.01) between 6 and 18 months, but patients with RVOT pacing did not (p > 0.05).

CONCLUSIONS:

This study demonstrates that preserved synchronous ventricular activation with RVOT pacing prevents the long-term deleterious effects of RVA pacing on myocardial perfusion and function in patients implanted with a permanent pacemaker.

PMID:
12392836
[Indexed for MEDLINE]
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