Key result
Right ventricular apex and septum pacing produced significantly higher variability in left ventricular electromechanical activation compared to Hisian area pacing (RVA vs HA EML variability P=0.0002).
Why the study?
Does Hisian area pacing improve left ventricular electromechanical activation compared to right ventricular apex and septum pacing in patients requiring pacing?
Observational (n=142)
Does Hisian area pacing improve left ventricular electromechanical activation compared to right ventricular apex and septum pacing in patients requiring pacing?
p-value: p=0.0002
Hisian area pacing selected by fluoroscopic and electrophysiological markers maintains a more homogeneous and less variable left ventricular activation pattern compared to right ventricular apical or septal pacing.
Hisian area pacing was associated with lower LV electromechanical variability; leaves open whether this improves clinical outcomes versus RV pacing.
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.
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Pastore et al. (2009) conducted an observational in Patients requiring cardiac pacing (n=142). Right ventricular apex (RVA) or right ventricular septum (RVS) pacing vs. Hisian area (HA) pacing was evaluated on Variability of left ventricular electromechanical activation (electromechanical latency and intra-LV dyssynchrony) (p=0.0002). Right ventricular apex and septum pacing produced significantly higher variability in left ventricular electromechanical activation compared to Hisian area pacing (RVA vs HA EML variability P=0.0002).
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