Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Yoshio Takemoto; Hideyuki Hasebe; Toshiyuki Osaka; Eriko Yokoyama; Yasunori Kushiyama; Tomoyuki Suzuki; Yusuke Kuroda; Chizuko Ichikawa; Kaichiro Kamiya; Itsuo Kodama

doi:10.1253/circj.CJ-09-0256

Arrhythmia/Electrophysiology

Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Yoshio Takemoto, Hideyuki Hasebe, Toshiyuki Osaka, Eriko Yokoyama, Yasunori Kushiyama, Tomoyuki Suzuki, Yusuke Kuroda, Chizuko Ichikawa, Kaichiro Kamiya, Itsuo Kodama

Author information

Yoshio Takemoto
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University
Hideyuki Hasebe
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Toshiyuki Osaka
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Eriko Yokoyama
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Yasunori Kushiyama
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Tomoyuki Suzuki
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Yusuke Kuroda
Division of Arrhythmia and Electrophysiology, Shizuoka Saiseikai General Hospital
Chizuko Ichikawa
Division of Clinical Laboratory, Shizuoka Saiseikai General Hospital
Kaichiro Kamiya
Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University
Itsuo Kodama
Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University

Keywords: Left ventricular dyssynchrony, Left ventricular function, QRS duration, Right ventricular pacing

JOURNAL FREE ACCESS

2009 Volume 73 Issue 10 Pages 1829-1835

DOI https://doi.org/10.1253/circj.CJ-09-0256

View "Advance Publication" version (August 19, 2009).

Details

Abstract

Background: Right ventricular septal (RVS) pacing is an alternative to right ventricular apical (RVA) pacing, but there is limited information about its influence on long-term left ventricular (LV) synchrony and function. Methods and Results: A total of 55 patients undergoing dual-chamber pacemaker implantation with normal QRS duration and preserved LV function at baseline were included in the study. The right ventricular lead was implanted on the septum where it would produce the shortest QRS duration possible in 40 patients and in the apex in 15. The time-to-peak systolic velocity (T_sys) was measured in 12 segments of the LV wall by tissue Doppler imaging. After a long (~4 years) follow-up period, the LV ejection fraction (LVEF) decreased significantly in patients with RVA pacing but not in those with RVS pacing. Paced QRS duration was significantly shorter during RVS than RVA pacing. T_sys dispersion among the 12 LV segments was significantly smaller during RVS than RVA pacing. There was a positive correlation between the paced QRS duration and T_sys dispersion (R=0.65, P<0.0001). The pacing-induced decrease in LVEF was positively correlated with the degree of T_sys dispersion (R=0.42, P=0.008). Conclusions: RVS pacing guided by the paced QRS morphology preserves long-term LV function via minimizing LV dyssynchrony. (Circ J 2009; 73: 1829-1835)

Corresponding author

Register with J-STAGE for free!