Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing.
OBJECTIVE
Left ventricular function may be altered by right ventricular apical pacing. The aims of the study were to compare the long-term course of different parameters of left ventricular dysfunction in patients undergoing implantation of a dual-chamber pacemaker with the ventricular lead in a septal position vs. in a standard apical position.


METHODS
We randomized 98 patients with atrioventricular block (AV-block) undergoing pacemaker implantation to positioning the ventricular lead in the high or mid septum (n = 53) or in the apex (n = 45) of the right ventricle. N-terminal pro-brain natriuetic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and exercise capacity were analysed 3 days, 3 months, and 18 months after the implantation. The primary endpoints were the changes of these parameters from baseline to 18 months.


RESULTS
Changes of BNP levels, LVEF, and exercise capacity from baseline to 18 months were statistically not different between septal and apical stimulation. The clinical occurrence or deterioration of overt heart failure was similar in both treatment arms.


CONCLUSIONS
With regard to different parameters of congestive heart failure, a septal stimulation site is not superior to conventional apical pacing in unselected patients undergoing pacemaker implantation for AV-block.
Kypta
Alexander
A
First Department of Internal Medicine, Cardiovascular Division, Academic Teaching and General Hospital Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
Steinwender
Clemens
C
Kammler
Jürgen
J
Leisch
Franz
F
Hofmann
Robert
R
D054537:Atrioventricular Block / Q000175:diagnosis* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006346:Heart Septum; D006352:Heart Ventricles; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome