Evolution of ventricular function during permanent pacing from either right ventricular apex or outflow tract following AV-junctional ablation for atrial fibrillation

To compare acute and chronic ventricular function between patients, without cardiac failure, paced at either right ventricular apex or outflow tract.

Twenty patients, 10 paced apically and 10 in the outflow tract, underwent two radionuclide ventriculograms. Eight parameters of systolic or diastolic function were compared at each assessment, as were changes within each group over time.

No differences were identified in systolic function between pacing sites 6 weeks after pacing or 23 weeks later. Peak filling rate was lower ( P =0·04) at the second assessment with outflow tract pacing. No other diastolic differences were identified. Between assessments, time to peak filling rate prolonged ( P =0·04) with apical pacing, while left ventricular area reduced ( P =0·04) and peak filling rate decreased ( P =0·04) with outflow tract pacing. Septal motion was better preserved with outflow tract pacing. No other parameter changed over time. ECG measures were similar at 14·7 months.

No major differences were identified in systolic function between pacing sites. Some systolic parameters were better preserved with outflow tract pacing and diastolic function deteriorated subtly over time in both groups. Right ventricular pacing adversely affects left ventricular function.