PMID- 14678131
OWN - NLM
STAT- MEDLINE
DCOM- 20040413
LR  - 20190911
IS  - 1045-3873 (Print)
IS  - 1045-3873 (Linking)
VI  - 14
IP  - 11
DP  - 2003 Nov
TI  - Right ventricular outflow versus apical pacing in pacemaker patients with 
      congestive heart failure and atrial fibrillation.
PG  - 1180-6
AB  - 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 < or = 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.
FAU - Stambler, Bruce S
AU  - Stambler BS
AD  - University Hospitals of Cleveland, Case Western Reserve University, 22200 Euclid 
      Avenue, Cleveland, Ohio 44106, USA. bss4@po.cwru.edu
FAU - Ellenbogen, KennethA
AU  - Ellenbogen K
FAU - Zhang, Xiaozheng
AU  - Zhang X
FAU - Porter, Thomas R
AU  - Porter TR
FAU - Xie, Feng
AU  - Xie F
FAU - Malik, Rajesh
AU  - Malik R
FAU - Small, Roy
AU  - Small R
FAU - Burke, Martin
AU  - Burke M
FAU - Kaplan, Andrew
AU  - Kaplan A
FAU - Nair, Lawrence
AU  - Nair L
FAU - Belz, Michael
AU  - Belz M
FAU - Fuenzalida, Charles
AU  - Fuenzalida C
FAU - Gold, Michael
AU  - Gold M
FAU - Love, Charles
AU  - Love C
FAU - Sharma, Arjun
AU  - Sharma A
FAU - Silverman, Russell
AU  - Silverman R
FAU - Sogade, Felix
AU  - Sogade F
FAU - Van Natta, Bruce
AU  - Van Natta B
FAU - Wilkoff, Bruce L
AU  - Wilkoff BL
CN  - ROVA Investigators
LA  - eng
PT  - Clinical Trial
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Cardiovasc Electrophysiol
JT  - Journal of cardiovascular electrophysiology
JID - 9010756
SB  - IM
CIN - J Cardiovasc Electrophysiol. 2003 Nov;14(11):1187-8. PMID: 14678132
MH  - Aged
MH  - Atrial Fibrillation/complications/*diagnosis/*therapy
MH  - Cardiac Pacing, Artificial/*methods
MH  - Cross-Over Studies
MH  - Heart Failure/*diagnosis/etiology/*therapy
MH  - Heart Ventricles/*innervation
MH  - Humans
MH  - *Pacemaker, Artificial
MH  - Quality of Life
MH  - Single-Blind Method
MH  - Treatment Outcome
MH  - Ventricular Dysfunction, Left/complications/*diagnosis/*therapy
EDAT- 2003/12/18 05:00
MHDA- 2004/04/14 05:00
CRDT- 2003/12/18 05:00
PHST- 2003/12/18 05:00 [pubmed]
PHST- 2004/04/14 05:00 [medline]
PHST- 2003/12/18 05:00 [entrez]
AID - 10.1046/j.1540-8167.2003.03216.x [doi]
PST - ppublish
SO  - J Cardiovasc Electrophysiol. 2003 Nov;14(11):1180-6. doi: 
      10.1046/j.1540-8167.2003.03216.x.