In:
Journal of Cardiovascular Electrophysiology, Wiley, Vol. 14, No. 11 ( 2003-11), p. 1180-1186
Abstract:
Introduction: Prior studies suggest that right ventricular apical (RVA) pacing has deleterious effects. Whether the right ventricular outflow tract (RVOT) is a more optimal site for permanent pacing in patients with congestive heart failure (CHF) has not been established. Methods and Results: We conducted a randomized, cross‐over trial to determine whether quality of life (QOL) is better after 3 months of RVOT than RVA pacing in 103 pacemaker recipients with CHF, left ventricular (LV) systolic dysfunction (LV ejection fraction ≤ 40%), and chronic atrial fibrillation (AF). An additional aim was to compare dual‐site (RVOT + RVA, 31‐ms delay) with single‐site RVA and RVOT pacing. QRS duration was shorter during RVOT (167 ± 45 ms) and dual‐site (149 ± 19 ms) than RVA pacing (180 ± 58 ms, P 〈 0.0001). At 6 months, the RVOT group had higher (P = 0.01) role‐emotional QOL subscale scores than the RVA group. At 9 months, there were no significant differences in QOL scores between RVOT and RVA groups. Comparing RVOT to RVA pacing within the same patient, mental health subscale scores were better (P = 0.03) during RVOT pacing. After 9 months of follow‐up, LVEF was higher (P = 0.04) in those assigned to RVA rather than RVOT pacing between months 6 and 9. After 3 months of dual‐site RV pacing, physical functioning was worse (P = 0.04) than during RVA pacing, mental health was worse (P = 0.02) than during RVOT pacing, and New York Heart Association (NYHA) functional class was slightly better (P = 0.03) than during RVOT pacing. There were no other significant differences between RVA, RVOT and dual‐site RV pacing in QOL scores, NYHA class, distance walked in 6 minutes, LV ejection fraction, or mitral regurgitation. Conclusion: In patients with CHF, LV dysfunction, and chronic AF, RVOT and dual‐site RV pacing shorten QRS duration but after 3 months do not consistently improve QOL or other clinical outcomes compared with RVA pacing. (J Cardiovasc Electrophysiol, Vol. 14, pp. 1180‐1186, November 2003)
Type of Medium:
Online Resource
ISSN:
1045-3873
,
1540-8167
DOI:
10.1046/j.1540-8167.2003.03216.x
Language:
English
Publisher:
Wiley
Publication Date:
2003
detail.hit.zdb_id:
2037519-0
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