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Variability of Left Ventricular Electromechanical Activation during Right Ventricular Pacing: Implications for the Selection of the Optimal Pacing Site
Author(s) -
PASTORE GIANNI,
ZA FRANCESCO,
NOVENTA FRANCO,
BARACCA ENRICO,
AGGIO SILVIO,
CORBUCCI GIORGIO,
CAZZIN ROBERTO,
RONCON LORIS,
BAROLD SERGE S.
Publication year - 2010
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.1540-8159.2009.02647.x
Subject(s) - medicine , cardiology , ventricular pacing , qrs complex , fluoroscopy , doppler echocardiography , surgery , heart failure , diastole , blood pressure
Background: The right ventricular septum (RVS) and Hisian area (HA) are considered more “physiological” pacing sites than right ventricular apex (RVA). Studies comparing RVS to RVA sites have produced controversial results. There are no data about variability of electromechanical activation obtained by an approach using fluoroscopy and electrophysiological markers. This study compared the variability of left ventricular (LV) electromechanical activation in patients undergoing short‐term RVA and RVS with that measured during HA pacing based on fluoroscopy and electrophysiological markers.Methods: Tissue Doppler echocardiography was performed in 142 patients before and after RVA (54), RVS (44), and HA (44) pacing. Electromechanical activation was assessed by: (1) electromechanical latency (EML)‐interval between QRS onset and mechanical activation of basal LV; (2) intra‐LV dyssynchrony (intra‐LV)‐interval between earliest to the latest LV basal motion. The intra‐ and interpatients variability among pacing groups were assessed.Results: Pacing from RVA showed longer EML and higher degree of intra‐LV than RVS and HA pacing. RVA and RVS showed a higher variability than HA pacing with regard to intrapatient changes of EML (RVA vs RVS, P = 0.4; RVS vs HA, P = 0.01, RVA vs HA, P = 0.0002) and intra‐LV (RVA vs RVS, P = 0.2; RVS vs HA, P = 0.04; RVA vs HA, P = 0.005). Similar results were found in interpatients variability from paced‐values.Conclusions: RVA and RVS pacing produce a variable effect on LV electromechanical activation that is significantly more pronounced than HA pacing. A pacing site such as HA selected by fluoroscopic and electrophysiological markers maintains baseline and homogeneous LV activation pattern. (PACE 2010; 566–574)