title: Comparison of effectiveness of right ventricular septal pacing versus right ventricular apical pacing.
abstract: Chronic right ventricular apical pacing (RVAP) has been associated with negative hemodynamic and clinical effects. The aim of the present study was to compare RVAP with right ventricular septal pacing (RVSP) in terms of echocardiographic features and clinical outcomes. A total of 93 patients without structural heart disease and with an indication for a permanent pacemaker were randomly assigned to receive a screw-in lead either in the RV apex (n = 46) or in the RV mid-septum (n = 47). The patients were divided into 3 subgroups according to the percentage of ventricular pacing: control group (n = 21, percentage of ventricular pacing < or =10%), RVAP group (n = 28), or RVSP group (n = 32; both latter groups had a percentage of ventricular pacing >10%). The RVAP group had more intraventricular dyssynchrony and a trend toward a worse left ventricular ejection fraction compared to the RVSP and control groups at 12 months of follow-up (maximal delay to peak systolic velocity between any of the 6 left ventricular basal segments was 57.8 +/- 38.2, 35.5 +/- 20.6, and 36.5 +/- 17.8 ms for RVAP, RVSP, and control group, respectively; p = 0.006; mean left ventricular ejection fraction 62.9 +/- 7.9%, 66.5 +/- 7.2%, and 66.6 +/- 7.2%, respectively, p = 0.14). Up to 48.1% of the RVAP patients showed significant intraventricular dyssynchrony compared to 19.4% of the RVSP patients and 23.8% of the controls (p = 0.04). However, no overt clinical benefits from RVSP were found. In conclusion, RVAP was associated with increased dyssynchrony compared to the RVSP and control patients. RVSP could represent an alternative pacing site in selected patients to reduce the harmful effects of traditional RVAP.
authors.affiliation: Electrophysiology Section, Cardiology Department, Hospital Universitario La Fe, Valencia, Spain. oscape13@hotmail.com
authors.forename: Oscar
authors.initials: O
authors.lastname: Cano
authors.forename: Joaquín
authors.initials: J
authors.lastname: Osca
authors.forename: María-José
authors.initials: MJ
authors.lastname: Sancho-Tello
authors.forename: Juan M
authors.initials: JM
authors.lastname: Sánchez
authors.forename: Víctor
authors.initials: V
authors.lastname: Ortiz
authors.forename: José E
authors.initials: JE
authors.lastname: Castro
authors.forename: Antonio
authors.initials: A
authors.lastname: Salvador
authors.forename: José
authors.initials: J
authors.lastname: Olagüe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D054537:Atrioventricular Block / Q000000981:diagnostic imaging / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000379:methods; D004562:Electrocardiography; D004867:Equipment Design; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012804:Sick Sinus Syndrome / Q000000981:diagnostic imaging / Q000628:therapy; D016037:Single-Blind Method; D016896:Treatment Outcome; D054088:Ventricular Septum