Key result
Practical septal pacing is linked to ~50% lower capture thresholds than His bundle pacing.
Why the study?
His bundle pacing preserves physiological pacing in atrioventricular block but may have unstable capture thresholds, motivating evaluation of practical septal pacing.
Does practical septal pacing improve capture thresholds and maintain narrow paced QRS duration compared to His bundle pacing in patients with atrioventricular block?
Cohort (n=92)
No
Does practical septal pacing improve capture thresholds and maintain narrow paced QRS duration compared to His bundle pacing in patients with atrioventricular block?
Practical septal pacing offers a simplified, ECG-guided alternative to His bundle pacing in AV block, providing comparable QRS narrowing with significantly more stable long-term capture thresholds.
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Practical septal pacing was associated with lower thresholds and similar QRS duration in AV block; hypothesis-generating, warranting randomized trials before practice change.
Background: His bundle pacing (HBP) preserves physiological pacing in atrioventricular block (AVB) but may have unstable thresholds. We evaluated practical septal pacing (PSP) for AVB. Methods and Results: We studied 92 AVB patients (41 HBP, 51 PSP). PSP was finalized at the narrowest attainable pQRSd with acceptable pacing parameters. Implant pQRSd was similar, while PSP had lower thresholds (0.5 vs. 1.0V; P<0.01) and remained lower at 18 months; thresholds ≥2.5V occurred less often (2% vs. 27%). No septal perforation occurred, and 1-year survival and heart failure hospitalization were comparable. Conclusions: PSP may offer a simple method with stable thresholds.
Takeuchi et al. (2026) conducted a cohort in Atrioventricular block (n=92). Practical septal pacing (PSP) vs. His bundle pacing (HBP) was evaluated on Capture threshold at implantation (V) (p=<0.01). Practical septal pacing resulted in significantly lower capture thresholds at implantation compared to His bundle pacing (0.5V vs. 1.0V, P<0.01) while maintaining similar paced QRS duration.
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