Key result
Right ventricular mid-septal pacing (n=50) decreased dyssynchrony and improved left ventricular ejection fraction compared with apical pacing (n=46) at 12 months, with no overt clinical benefits.
Why the study?
Does right ventricular mid-septal pacing improve echocardiographic and clinical features compared to apical pacing in patients with high-degree atrioventricular block?
RCT (n=96)
Does right ventricular mid-septal pacing improve echocardiographic and clinical features compared to apical pacing in patients with high-degree atrioventricular block?
Right ventricular mid-septal pacing is associated with decreased dyssynchrony and better left ventricular ejection fraction compared to apical pacing, though it may not provide overt clinical benefits at 12 months.
Supports mid-septal over apical RV pacing to preserve LVEF in high-degree AV block; extends randomized evidence on pacing site selection beyond clinical endpoints.
The aim of the present study was to compare conventional right ventricular apical pacing (RVAP) with right ventricular mid-septal pacing (RVMSP) in terms of echocardiographic and clinical/biologic features. Ninety-six patients with high-degree atrioventricular block were randomly allocated to RVMSP (n = 50) and RVAP (n = 46). Threshold and impedance, echocardiographic left ventricular ejection fraction, ventricular dyssynchrony features, and distance during a 6-min walk test and Minnesota Living with Heart Failure Questionnaire were determined at 6 and 12 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide were measured. At 6 months of follow-up, echocardiographic and clinical/biologic features showed no significant differences between two groups. The RVAP group had more intraventricular dyssynchrony and a trend towards a worse left ventricular ejection fraction compared with the RVMSP at 12 months of follow-up. However, no overt clinical benefits from RVMSP were found. Right ventricular mid-septal pacing was associated with decreased dyssynchrony and better left ventricular ejection fraction compared with the RVAP. Right ventricular mid-septal pacing could represent an alternative pacing site in selected patients to reduce the harmful effects of traditional RVAP.
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Bai et al. (2016) conducted an RCT in high-degree atrioventricular block (n=96). Right ventricular mid-septal pacing (RVMSP) vs. Right ventricular apical pacing (RVAP) was evaluated on Echocardiographic and clinical/biologic features. Right ventricular mid-septal pacing (n=50) decreased dyssynchrony and improved left ventricular ejection fraction compared with apical pacing (n=46) at 12 months, with no overt clinical benefits.
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