Selective site pacing from the right ventricular mid-septum resulted in a markedly shorter mean QRS duration compared to conventional RV apical pacing (123 vs 150 msec, P<0.0001).
Observational (n=238)
Does selective site pacing from the right ventricular mid-septum improve pacemaker indices and reduce QRS duration compared to conventional RV apical pacing in patients requiring permanent pacemakers?
Right ventricular mid-septal pacing is feasible and results in a more physiological activation pattern with shorter QRS duration compared to traditional apical pacing.
Absolute Event Rate: 123% vs 150%
p-value: p=<0.0001
Pacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied. A screw-in lead and a curved stylet were used for lead positioning on the RV mid-septum. Pacemaker indices were evaluated at implantation and one year later. As an electrocardiographic parameter, QRS duration was measured in lead II. These data were compared to those of 66 patients subjected to conventional RV apical pacing. Lead placement was successful in all patients of RV mid-septal pacing. There were no technical problems during or after the procedure. The cumulative percentage of ventricular pacing at one year postimplantation was 85 ± 24 % in the SSP group. Sensing, pacing threshold, and lead impedance in the SSP group remained clinically stable over one year. When these measurements were compared between the SSP and AP groups, the pacing threshold and the lead impedance at one year postimplantation in the SSP group were higher (P < 0.05) and lower (P < 0.01), respectively, than those of the AP group. The mean QRS duration was markedly shorter (123 ± 16 versus 150 ± 18 msec, P < 0.0001). Selective site pacing from the RV mid-septum is feasible and results in less conduction delay compared to conventional RV apical pacing, and its procedure seems to be more physiological in permanent pacemaker implantation.
Yusu et al. (2012) conducted an observational in Indications for permanent pacemaker implantation (n=238). Selective site pacing from the right ventricular mid-septum vs. Conventional right ventricular apical pacing was evaluated on Mean QRS duration (p=<0.0001). Selective site pacing from the right ventricular mid-septum resulted in a markedly shorter mean QRS duration compared to conventional RV apical pacing (123 vs 150 msec, P<0.0001).
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