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J Am Coll Cardiol, 2002; 40:1451-1458
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CARDIAC ARRHYTHMIAS

Functional abnormalities in patients with permanent right ventricular pacing

The effect of sites of electrical stimulation

Hung-Fat Tse, MD, FACC*,*, Cannas Yu, MPhil*, Kwong-Kuen Wong, MBBS{dagger}, Vella Tsang, RN*, Yim-Lung Leung, MBBS{dagger}, Wai-Yin Ho, MBBS{dagger} and Chu-Pak Lau, MD, FACC*

* Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, China
{dagger} Department of Nuclear Medicine, Queen Mary Hospital, Hong Kong, China

Manuscript received February 27, 2002; revised manuscript received May 12, 2002, accepted May 31, 2002.

* Reprint requests and correspondence: Dr. Hung-Fat Tse, Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
hftse{at}hkucc.hku.hk

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.

Abbreviations and Acronyms
  AV
  atrioventricular
  ECG
  electrocardiogram/electrocardiographic
  LV
  left ventricle/ventricular
  LVEF
  left ventricular ejection fraction
  RV
  right ventricle/ventricular
  RVA
  right ventricular apex
  RVOT
  right ventricular outflow tract
  Tl-201
  thallium-201




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