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Influence of Native Conduction Status on Clinical
Results With Right Ventricular Outflow Tract Pacing
Michael C. Giudici, MD, S. Serge Barold,
Cindy J. Meierbachtol, BSN, Deborah L. Paul,
any studies have demonstrated the hemodynamic superiority of pacing the right ventricular
-5
(RV) outflow tract compared with the RV apex.'
Normalization of the axis of depolarization during RV
outflow tract pacing may influence contractility by
decreasing anisotropic ventricular conduction. Other
possible mechanisms include a narrower paced QRS
complex and the possibility of activating the HisPurkinje system by pacing near the right bundle
branch. Based on these considerations, we analyzed
the consequences of pacing the RV outflow tract ver-
M
From the Division of Cardiology, Genesis Heart Institute, Davenport,
I owa; and the Division of Cardiology, Tampa General Hospital,
Tampa, Florida. Dr. Giudici's address is: Genesis Heart Institute,
1 236 East Rusholme, Suite 300, Davenport, Iowa 52803. E-mail.
[email protected] . Manuscript received March 1 9, 2002; revised manuscript received and accepted August 27, 2002.
240
©2003 by Excerpta Medico, Inc. All rights reserved.
The American Journal of Cardiology Vol. 91 January 15, 2003
MD,
RTR,
Angela L. Moeller, RN,
and Mary C. Walton,
PhD
sus the apex according to underlying conduction abnormalities and manifestations of pacing in terms of
mean frontal plane axis and duration of the paced QRS
complex.
We analyzed data from 91 patients (31 women and
60 men, mean age 68 years [range 26 to 94]) who
underwent permanent RV outflow tract pacing for sick
sinus syndrome (n = 14), atrioventricular block (n =
18), or induced atrioventricular block by ablation for
atrial tachyarrhythmias (n = 53). Baseline conduction
status before pacemaker implantation was normal in
33 patients, and showed complete left bundle branch
block in 15 (QRS > 120 ms), complete right bundle
branch block in 11 (QRS > 120 ms), left ventricular
hypertrophy and/or incomplete left bundle branch
block in 22, and other intraventricular conduction
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The American Journal of Cardiology Vol. 91 January 15, 2003
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