title: Effects of right ventricular pacing sites on blood pressure variation in upright posture: a comparison of septal vs. apical pacing sites.
abstract: OBJECTIVE
  Large variations in blood pressure (BP) in the upright position are a major cause of pacemaker syndrome, observed in up to 80% of patients paced non-physiologically at the right ventricular (RV) apex. We hypothesized that the magnitude of BP variations might be influenced by the RV pacing site. To assess this, we compared haemodynamic findings during supine and upright posture with RV apical vs. septal pacing.
  
  
  RESULTS
  The study population comprised a retrospective cohort of 24 dual-chamber pacemaker patients with advanced or complete atrioventricular block, in which 11 were randomly chosen from those with RV apical pacing, and 13 randomly chosen from those with septal pacing. Studies were performed during fixed rate VVI and DDD pacing modes with patients in both supine and passive head-up tilt positions. Continuous BP, stroke volume, cardiac index, and total peripheral resistance index were measured non-invasively. During RV apical pacing, there were significant differences of beat-to-beat BP variation after movement from supine to upright posture for both VVI and DDD pacing modes (P < 0.05); however, this was not the case for either mode during RV septal pacing. Further, comparing RV apical to RV septal pacing in the supine position, there were no BP variation differences for either DDD or VVI modes. Conversely, in the upright position BP variation was significantly greater during RV apical vs. RV septal VVI pacing (P = 0.017) but not during DDD pacing.
  
  
  CONCLUSIONS
  During VVI pacing, RV septal pacing exhibited lesser BP variation during upright posture compared with RV apical pacing.
authors: Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan.
authors: Ritsuko
authors: R
authors: Kohno
authors: Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan haru-abe@med.uoeh-u.ac.jp.
authors: Haruhiko
authors: H
authors: Abe
authors: Japan Research Institute for Device Therapy, Tokyo, Japan.
authors: Hiroshi
authors: H
authors: Nakajima
authors: Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan.
authors: Katsuhide
authors: K
authors: Hayashi
authors: Department of Heart Rhythm Management, University of Occupational and Environmental Health, 1-1, Iseigaoka Yahatanishiku, Kitakyushu 807-8555, Japan.
authors: Yasushi
authors: Y
authors: Oginosawa
authors: Cardiac Arrhythmia Center, Cardiovascular Division, University of Minnesota, Minneapolis, MN, USA.
authors: David G
authors: DG
authors: Benditt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D054537:Atrioventricular Block / Q000628:therapy*; D001794:Blood Pressure; D001795:Blood Pressure Determination; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007564:Japan; D008297:Male; D010138:Pacemaker, Artificial; D011187:Posture / Q000502:physiology*; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology
keywords: Blood pressure control; Pacemaker syndrome; Septal pacing