{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T22:09:54Z","timestamp":1787004594164,"version":"build-2736575974"},"reference-count":21,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2003,11,14]],"date-time":"2003-11-14T00:00:00Z","timestamp":1068768000000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cardiovasc electrophysiol"],"published-print":{"date-parts":[[2003,11]]},"abstract":"<jats:p>\n                    <jats:italic>Introduction:<\/jats:italic>\n                    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.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Methods and Results:<\/jats:italic>\n                    We conducted a randomized, cross\u2010over 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 \u2264 40%), and chronic atrial fibrillation (AF). An additional aim was to compare dual\u2010site (RVOT + RVA, 31\u2010ms delay) with single\u2010site RVA and RVOT pacing. QRS duration was shorter during RVOT (167 \u00b1 45 ms) and dual\u2010site (149 \u00b1 19 ms) than RVA pacing (180 \u00b1 58 ms, P &lt; 0.0001). At 6 months, the RVOT group had higher (P = 0.01) role\u2010emotional 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\u2010up, 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\u2010site 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\u2010site RV pacing in QOL scores, NYHA class, distance walked in 6 minutes, LV ejection fraction, or mitral regurgitation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion:<\/jats:italic>\n                    In patients with CHF, LV dysfunction, and chronic AF, RVOT and dual\u2010site RV pacing shorten QRS duration but after 3 months do not consistently improve QOL or other clinical outcomes compared with RVA pacing.\n                    <jats:italic>(J Cardiovasc Electrophysiol, Vol. 14, pp. 1180\u20101186, November 2003)<\/jats:italic>\n                  <\/jats:p>","DOI":"10.1046\/j.1540-8167.2003.03216.x","type":"journal-article","created":{"date-parts":[[2003,11,14]],"date-time":"2003-11-14T09:39:28Z","timestamp":1068802768000},"page":"1180-1186","source":"Crossref","is-referenced-by-count":179,"title":["Right Ventricular Outflow Versus Apical Pacing in 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