Right ventricular apex pacing was not significantly different from high septum pacing for decreasing LV end-systolic volume by >15% at 6 months (65% vs 64%, P=0.76).
Cohort (n=73)
Does right ventricular high septum pacing improve echocardiographic response compared to right ventricular apical pacing in patients with advanced heart failure receiving CRT?
Overall right ventricular lead location (apex vs. high septum) does not significantly affect CRT response, but the optimal right ventricular site may depend on the specific left ventricular stimulation site.
Absolute Event Rate: 65% vs 64%
p-value: p=0.76
It is currently recommended to implant the left ventricular (LV) pacing lead at the lateral wall. However, the optimal right ventricular (RV) pacing lead location for cardiac resynchronization therapy (CRT) remains controversial. We sought to investigate whether optimizing the site for placement of the RV lead could further improve the long-term response to CRT in patients with advanced heart failure. Between October 2006 and December 2007, a total of 73 consecutive patients with standard indication for CRT were enrolled. The enrolled patients were divided into two groups based on the RV lead location. There were 50 patients in RV apex (RVA) group and 23 patients in RV high septum (RVHS). The primary study endpoint was a decrease in LV end-systolic volume (LVESV) by >15% at 6-month follow-up. The secondary endpoints were improvement in New York Heart Association (NYHA) class by ≥1 point and decrease in brain-type natriuretic peptide (BNP) levels by >50% after CRT. At 6-month follow-up, improvement in NYHA class by ≥1 point (RVA: 72% vs. RVHS: 74%, P = 0.76), decrease in LVESV by ≥15% (RVA: 65% vs. RVHS: 64%, P = 0.76), and decrease in BNP level by >50% (RVA: 70% vs. RVHS: 69%, P = 0.88) were observed in similar proportion of the two groups. When we separately assessed the significance of RV pacing site in three LV stimulation sites, there were no significant differences in terms of clinical improvement (62 vs. 64%, P = 0.74) and decrease in LVESV by >15% (63 vs. 62%, P = 0.78) between RVA and RVHS pacing when the LV stimulation site was lateral cardiac vein. In anterolateral vein pacing site, the RVA stimulation was associated with higher clinical (88 vs. 47%, P = 0.05), echocardiographic (75 vs. 32%, P = 0.02), and neurohormonal responses (80 vs. 50%, P = 0.04) compared with that in RVHS site. When LV was paced from posterolateral vein, RVHS pacing was superior to RVA in terms of the clinical improvement (85 vs. 35%, P = 0.01), echocardiographic response (72 vs. 30%, P = 0.01), and decrease in BNP levels (75 vs. 50%, P = 0.04). The present study did not show any difference between RVA and RVHS pacing sites in terms of overall improvement in clinical outcome and LV reverse remodelling following CRT. However, effect of RV lead location on CRT response varies depending on LV stimulation site.
Haghjoo et al. (Sat,) conducted a cohort in Advanced heart failure (n=73). Right ventricular apex (RVA) pacing lead location vs. Right ventricular high septum (RVHS) pacing lead location was evaluated on Decrease in LV end-systolic volume (LVESV) by >15% at 6-month follow-up (p=0.76). Right ventricular apex pacing was not significantly different from high septum pacing for decreasing LV end-systolic volume by >15% at 6 months (65% vs 64%, P=0.76).