Key result
CT-verified right ventricular septal lead position was associated with a similar risk of pacing-induced cardiomyopathy compared to non-septal position (33.3% vs 29.5%; p=0.6).
Why the study?
Prospective studies using fluoroscopy to assess RV lead position have failed to show clear benefits from RV septal pacing, prompting investigation using CT verification.
Does CT-verified right ventricular septal lead position reduce the risk of pacing-induced cardiomyopathy compared to non-septal position in patients with high-degree atrioventricular block and normal pre-implant LVEF?
Cohort (n=153)
Does CT-verified right ventricular septal lead position reduce the risk of pacing-induced cardiomyopathy compared to non-septal position in patients with high-degree atrioventricular block and normal pre-implant LVEF?
Absolute Event Rate: 33.3% vs 29.5%
p-value: p=0.6
CT-verified right ventricular septal lead position does not significantly reduce the risk of pacing-induced cardiomyopathy compared to non-septal position in patients with high-degree AV block and normal baseline LVEF.
CT verification of RV lead position may refine PICM risk assessment; leaves open optimal site selection in prospective trials.
Prospective studies applying fluoroscopy for assessment of right ventricular (RV) lead position have failed to show clear benefits from RV septal pacing. We investigated the impact of different RV lead positions verified by computed tomography (CT) on the risk of pacing-induced cardiomyopathy (PICM). We retrospectively included 153 patients who underwent routine fluoroscopy-guided pacemaker implantation between March 2012 and May 2020. All patients had normal pre-implant left ventricular ejection fraction (LVEF). Patients attended a follow-up visit including contrast-enhanced cardiac CT and transthoracic echocardiography. Patients were classified as septal or non-septal based on CT analysis. The primary endpoint was PICM (LVEF < 50% with ≥10% decrease after implantation). Based on CT, 48 (31.4%) leads were septal and 105 (68.6%) were non-septal. Over a median follow-up of 3.1 years, 16 patients (33.3%) in the septal group developed PICM compared to 31 (29.5%) in the non-septal group (p = 0.6). Overall, 13.1% deteriorated to LVEF ≤ 40%, 5.9% were upgraded to cardiac resynchronization therapy device, and 14.4% developed new-onset atrial fibrillation, with no significant differences between the groups. This study demonstrated a high risk of PICM despite normal pre-implant left ventricular systolic function with no significant difference between CT-verified RV septal or non-septal lead position.
No takes yet. Share an insight, caveat, or question.
Fruelund et al. (2022) conducted a cohort in High-Degree Atrioventricular Block (n=153). Right ventricular septal lead position vs. Non-septal lead position was evaluated on Pacing-induced cardiomyopathy (LVEF < 50% with ≥10% decrease after implantation) (p=0.6). CT-verified right ventricular septal lead position was associated with a similar risk of pacing-induced cardiomyopathy compared to non-septal position (33.3% vs 29.5%; p=0.6).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: