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CLINICAL STUDIES

Influence of right ventricular stimulation site on left ventricular function in atrial synchronous ventricular pacing

^a Medizinische Klinik, Innere Medizin III, Universitätskliniken des Saarlandes, Homburg/Saar, Germany
^* Radiologische Klinik, Abteilung für Nuklearmedizin, Universitätskliniken des Saarlandes, Homburg/Saar, Germany

Manuscript received March 20, 1998; revised manuscript received August 17, 1998, accepted October 6, 1998.

Reprint requests and correspondence: Dr. Bernhard Schwaab, Universitätskliniken, Innere Medizin III, 66421 HOMBURG/Saar, Germany

OBJECTIVES

The study investigates the correlation between left ventricular function and QRS duration obtained by alternate right ventricular pacing sites.

BACKGROUND

1. Right ventricular apical pacing is associated with alterations of left ventricular contraction sequence. 2. A stimulation producing narrow QRS complexes is supposed to provide for better left ventricular contraction patterns.

METHODS

Fourteen patients with third degree AV block received one ventricular pacing lead in apical position. The alternate lead was attached to that site on the septum that produced the smallest QRS complex as measured from the earliest to the last deflection in any of the orthogonal Frank leads (xyz). During atrial synchronous ventricular pacing, the AV delay was optimized individually and for each stimulation site using mitral valve doppler or impedance cardiography. By radionuclide ventriculography, the phase distribution histogram of left ventricular contraction was evaluated as area under the curve (AuC); systolic function was determined as ejection fraction (EF) and as absolute ejected counts (EC) in random order. The difference () in QRS duration between apical and septal stimulation (xyz) was correlated with the difference in phase distribution (AuC) and ejection parameters (EF, EC).

RESULTS

QRS duration was shorter with septal than with apical pacing in 9 out of 14 patients (64%); it was longer in 4 (29%), and no difference was seen in 1 patient. There was a significant positive correlation between the change in QRS duration (xyz) and phase distribution (AuC: r = 0.66393, p = 0.010) and a significant negative correlation to systolic function (EF: r = 0.70931, p = 0.004; EC: r = 0.74368, p = 0.002).

CONCLUSIONS

In atrial synchronous right ventricular pacing, if the AV delay is adapted individually, decreased QRS duration obtained by alternate pacing sites is significantly correlated with homogenization of left ventricular contraction and with increased systolic function in acute tests.

Abbreviations and Acronyms   AuC = area under the curve   AAT = atrial pacing is triggered by atrial sensing   VDD = atrial synchronous ventricular pacing   AV = atrioventricular   DDD = AV sequential pacing   ROI = region of interest   RVA = right ventricular apical   RVOT = right ventricular outflow tract   RVS = right ventricular septal

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