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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, Vella Tsang, RN^*, Yim-Lung Leung, MBBS, Wai-Yin Ho, MBBS and Chu-Pak Lau, MD, FACC^*

^* Cardiology Division, Department of Medicine, University of Hong Kong, Hong Kong, China
Department of Nuclear Medicine, Queen Mary Hospital, Hong Kong, China

View larger version (102K): [in a new window]   Figure 1 Fluoroscopic images of the (left) posteroanterior (PA) and (right) left anterior oblique (LAO) projection, showing the position of the active ventricular pacing lead at the right ventricular outflow tract (arrow).

View larger version (70K): [in a new window]   Figure 2 Twelve-lead electrocardiogram of a patient who underwent right ventricular outflow tract pacing, showing a QRS duration of 135 ms with a left bundle branch block pattern and inferior axis.

View larger version (19K): [in a new window]   Figure 3 The summed rest (upper panel) and stress (lower panel) scores for dipyridamole thallium-201 myocardial scintigraphy after 6 and 18 months of right ventricular apex (RVA) (solid bars) and right ventricular outflow tract (RVOT) (open bars) pacing. The summed rest and stress scores during RVA pacing at 18 months were significantly higher than those during RVOT pacing at 18 months (p < 0.05) and during RVA pacing at 6 months (p < 0.05).

View larger version (24K): [in a new window]   Figure 4 Regional left ventricular ejection fraction (EF) at the lateral, inferior, apical, septal, and anterior regions after 6 and 18 months of right ventricular apex (RVA) and right ventricular outflow tract (RVOT) pacing.

View larger version (21K): [in a new window]   Figure 5 Global left ventricular ejection fraction (LVEF) (upper panel) and left ventricular diastolic function (lower panel) after 6 and 18 months of right ventricular apex (RVA) (solid bars) and right ventricular outflow tract (RVOT) (open bars) pacing. The LVEF during RVA pacing at 18 months was significantly lower than that during RVOT pacing at 18 months (p < 0.05) and during RVA pacing at 6 months (p < 0.05). At both 6 and 18 months, the peak ventricular filling rate during RVA pacing was lower than that during RVOT pacing (p < 0.05).