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Impact of Right Ventricular Pacing Sites on Exercise Capacity during Ventricular Rate Regularization in Patients with Permanent Atrial Fibrillation
Author(s) -
TSE HUNGFAT,
SIU CHUNGWAH,
LAU CHUPAK
Publication year - 2009
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2009.02575.x
Subject(s) - medicine , cardiology , atrial fibrillation , bradycardia , ventricular pacing , qrs complex , heart rate , cardiac pacing , anesthesia , ventricular rate , heart failure , blood pressure , sinus rhythm
Background:The deleterious effects of right ventricular apical (RVA) pacing may offset the potential benefit of ventricular rate (VR) regularization and rate adaptation during an exercise in patient's atrial fibrillation (AF).Methods:We studied 30 patients with permanent AF and symptomatic bradycardia who receive pacemaker implantation with RVA (n = 15) or right ventricular septal (RVS, n = 15) pacing. All the patients underwent an acute cardiopulmonary exercise testing using VVI‐mode (VVI‐OFF) and VVI‐mode with VR regularization (VRR) algorithm on (VVI‐ON).Results:There were no significant differences in the baseline characteristics between the two groups, except pacing QRS duration was significantly shorter during RVS pacing than RVA pacing (138.9 ± 5 vs 158.4 ± 6.1 ms, P = 0.035). Overall, VVI‐ON mode increased the peak exercise VR, exercise time, metabolic equivalents (METs), and peak oxygen consumption (VO 2 max), and decreased the VR variability compared with VVI‐OFF mode during exercise (P < 0.05), suggesting that VRR pacing improved exercise capacity during exercise. However, further analysis on the impact of VRR pacing with different pacing sites revealed that only patients with RVS pacing but not patients with RVA pacing had significant increased exercise time, METs, and VO 2 max during VVI‐ON compared with VVI‐OFF, despite similar changes in peaked exercise VR and VR variability.Conclusion:In patients with permanent AF, VRR pacing at RVS, but not at RVA, improved exercise capacity during exercise.