title: Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator.
  
  
  RESULTS
  Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 ± 39.4 mL in RVS group vs. -29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of 'echo-responders' defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401).
  
  
  CONCLUSIONS
  This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study.
  NCT 00833352.
authors.affiliation: Centre Hospitalier Universitaire, Rennes, France Université Rennes 1, Rennes, France Université Inserm U642, Rennes, France christophe.leclercq@chu-rennes.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Leclercq
authors.affiliation: Centre Hospitalier Universitaire, Nancy, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Sadoul
authors.affiliation: Hospital Clinic Universitat de Barcelona, Catalonia, Spain.
authors.forename: Lluis
authors.initials: L
authors.lastname: Mont
authors.affiliation: Centre Hospitalier Universitaire, Grenoble, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Defaye
authors.affiliation: Hospital La Fé, Valencia, Spain.
authors.forename: Joaquim
authors.initials: J
authors.lastname: Osca
authors.affiliation: Boston Scientific SAS, Voisins le Bretonneux, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Mouton
authors.affiliation: Centre Hospitalier Universitaire la Pitié-Salpêtrière, Paris, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Isnard
authors.affiliation: Centre Hospitalier Universitaire La Timone, Marseille, France.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Habib
authors.affiliation: University Hospital Ramón y Cajal, Madrid, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Zamorano
authors.affiliation: DHU A-TVB, Hôpital Henri Mondor, Créteil, France.
authors.forename: Genevieve
authors.initials: G
authors.lastname: Derumeaux
authors.affiliation: Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Fernandez-Lozano
mesh_terms: D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017147:Defibrillators, Implantable; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D016037:Single-Blind Method; D016896:Treatment Outcome
keywords: Cardiac resynchronization therapy; Left ventricular end-systolic volume; Right ventricular defibrillation lead; Right ventricular lead position