CLINICAL RESEARCH: ELECTROPHYSIOLOGY
Acute comparative effect of right and left ventricular pacing in patients with permanent atrial fibrillation
Enrico Puggioni, MD*,
Michele Brignole, MD*,*,
Michael Gammage, MD ,
Ezio Soldati, MD ,
Maria Grazia Bongiorni, MD,
Emmanuael N. Simantirakis, MD ,
Panos Vardas, MD,
Fredrik Gadler, MD||,
Lennart Bergfeldt, MD||,
Corrado Tomasi, MD¶,
Giacomo Musso, MD#,
Gianni Gasparini, MD** and
Attilio Del Rosso, MD
* Ospedali del Tigullio, Lavagna, Italy
Queen Elizabeth Hospital, Birmingham, United Kingdom
Ospedale S. Chiara, Pisa, Italy
University Hospital, Heraklion, Greece
|| Karolinska Hospital, Stockholm, Sweden
¶ Ospedale S. Maria Nuova, Reggio Emilia, Italy
# Ospedale Civile, Imperia, Italy
** Ospedale Umberto I, Mestre, Italy
Ospedale S. Pietro Igneo, Fucecchio, Italy
Manuscript received June 14, 2003;
revised manuscript received August 2, 2003,
accepted September 8, 2003.
* Reprint requests and correspondence: Dr. Michele Brignole, Head of the Department of Cardiology, Ospedali del Tigullio, Via don Bobbio, 16033 Lavagna, Italy.
mbrignole{at}ASL4.liguria.it
OBJECTIVES: We tested the hypothesis that left ventricular (LV) pacing is superior to right ventricular (RV) apical pacing in patients undergoing atrioventricular (AV) junction ablation and pacing for permanent atrial fibrillation.
BACKGROUND: The potential benefit of LV over RV pacing needs to be evaluated without the confounding effect of other variables that can influence cardiac performance.
METHODS: An acute intrapatient comparison of the QRS width and echocardiographic parameters between RV versus LV pacing was performed within 24 h after ablation in 44 patients. Both modes of pacing were also compared with pre-implantation values.
RESULTS: Compared with RV pacing, LV pacing caused a 5.7% increase in the ejection fraction (EF) and a 16.7% decrease in the mitral regurgitation (MR) score; the QRS width was 4.8% shorter with LV pacing. Similar results were observed in patients with or without systolic dysfunction and/or native left bundle branch block, except for a greater improvement in MR in the latter group. Compared with pre-ablation measures, the EF increased by 11.2% and 17.6% with RV and LV pacing, respectively; the MR score decreased by 0% and 16.7%; and the diastolic filling time increased by 12.7% and 15.6%.
CONCLUSIONS: Rhythm regularization achieved with AV junction ablation improved EF with both RV and LV pacing; LV pacing provided an additional modest but favorable hemodynamic effect, as reflected by a further increase of EF and reduction of MR. The effect seems to be equal in patients with both depressed and preserved systolic functions and in those with and without native left bundle branch block.
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Abbreviations and Acronyms
| | AF | = atrial fibrillation | | AV | = atrioventricular | | EF | = ejection fraction | | LBBB | = left bundle branch block | | LV | = left ventricle/ventricular | | MR | = mitral regurgitation | | OPSITE | = Optimal Pacing Site study | | RV | = right ventricle/ventricular |
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