What question did this study set out to answer?

To determine whether right ventricular septal lead placement preserves left ventricular function better than standard apical pacing over 18 months in patients with atrioventricular block.

April 7, 2008EP EuropaceOpen Access

Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing

Q: What does this research mean for the field?

In patients with atrioventricular block, right ventricular septal pacing is not superior to conventional apical pacing for preserving left ventricular function or preventing heart failure over an 18-month period. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Why the study?

Does septal ventricular lead implantation improve surrogate markers of left ventricular dysfunction compared to standard apical pacing in patients with atrioventricular block?

Population

98 patients with atrioventricular block (AV-block) undergoing dual-chamber pacemaker implantation

Comparison

Dual-chamber pacemaker implantation with the… vs Dual-chamber pacemaker implantation with the…

Design

RCT, Randomized (method not specified)

Follow-up

18 months

Authors

AKAlexander KyptaJohannes Kepler University of Linz CSClemens SteinwenderElectrophysiology JKJuergen KammlerJohannes Kepler University of Linz

Discussion

Member takes

Implication

Septal pacing shows no LV surrogate benefit over apical in AV block; challenges septal preference and supports apical as standard.

Key Points

To determine whether right ventricular septal lead placement preserves left ventricular function better than standard apical pacing over 18 months in patients with atrioventricular block.
Randomized trial allocating 98 patients with atrioventricular block undergoing dual-chamber pacemaker implantation to high/mid septal (n = 53) or apical (n = 45) right ventricular lead placement.
Assessed changes in N-terminal pro-brain natriuretic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and exercise capacity at 3 days, 3 months, and 18 months, with 18-month change from baseline as primary endpoints.
Changes from baseline to 18 months in BNP levels, LVEF, and exercise capacity did not differ significantly between septal and apical pacing groups (numerical values not reported).
Rates of clinical onset or deterioration of overt heart failure did not differ significantly between the two pacing arms.

Structured PICO

Does septal ventricular lead implantation improve surrogate markers of left ventricular dysfunction compared to standard apical pacing in patients with atrioventricular block?

Population

98 patients with atrioventricular block (AV-block) undergoing dual-chamber pacemaker implantation

Intervention

Dual-chamber pacemaker implantation with the ventricular lead positioned in the high or mid septum of the right ventricle

Comparator

Dual-chamber pacemaker implantation with the ventricular lead positioned in the standard apical position of the right ventricle

Outcome

Changes in N-terminal pro-brain natriuretic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and exercise capacity from baseline to 18 monthssurrogate

Septal right ventricular pacing is not superior to conventional apical pacing for preserving left ventricular function or preventing heart failure in patients with atrioventricular block.

Cite This Study

Kypta et al. (2008) studied this question.

synapsesocial.com/papers/6a1bf4f7ea84844e355f3a62 https://doi.org/10.1093/europace/eun085

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Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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