Key result
RV mid-septal and RVOT septal pacing were associated with significantly lower paced QRS duration (139.6 ms for both) compared to apical pacing (148.9 ms; p=0.003 and p=0.002, respectively).
Why the study?
Does RV mid-septal or RVOT septal pacing reduce paced QRS duration compared to apical pacing in patients undergoing pacemaker implantation?
Observational (n=252)
Does RV mid-septal or RVOT septal pacing reduce paced QRS duration compared to apical pacing in patients undergoing pacemaker implantation?
Absolute Event Rate: 139.6% vs 148.9%
p-value: p=0.003 and 0.002
RV mid-septal and RVOT septal pacing result in significantly narrower paced QRS durations compared to apical pacing, suggesting a more physiological pacing site.
Mid-septal or RVOT pacing may narrow QRS versus apical; leaves open effects on clinical outcomes in pacemaker patients.
BACKGROUND: Pacing from RV mid septum and outflow tract septum has been proposed as a more physiological site of pacing and narrower paced QRS complex duration. The paced QRS morphology and duration in different RV pacing sites is under continued discussion. Hence, this study was designed to address the correlation of pacing sites in right ventricle with paced QRS complex duration. METHODS: Two hundred fifty-two consecutive patients who underwent pacemaker implantation were enrolled. Baseline clinical characteristics were recorded for each patient. All patient underwent fluoroscopy, electrocardiogram and echocardiography post pacemaker implantation. Paced QRS duration was calculated from the leads with maximum QRS duration. RESULTS: Mean paced QRS (pQRS) duration was significantly higher in apical septum group with a mean of 148.9 ± 14.8 m s compared to mid septum (139.6 ± 19.9 m s; p-value 0.003) and RVOT septum (139.6 ± 14.8 m s; p-value 0.002) groups, respectively. There was no significant difference between mid-septal and RVOT septal pQRS duration. On multivariate analysis, female gender, baseline QRS duration and RVOT septal pacing were the only predictors for narrow pQRS duration (<150 msec). CONCLUSION: RV mid-septal and RVOT septal pacing were associated with significantly lower pQRS duration as compared with apical pacing. Based on multivariate analysis RVOT septal pacing appears to be preferred and more physiological pacing site.
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Gupta et al. (2018) conducted an observational in Pacemaker implantation (n=252). RV mid-septal and RVOT septal pacing vs. Apical septal pacing was evaluated on Paced QRS duration (p=0.003 and 0.002). RV mid-septal and RVOT septal pacing were associated with significantly lower paced QRS duration (139.6 ms for both) compared to apical pacing (148.9 ms; p=0.003 and p=0.002, respectively).
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