Key result
Superficial RVMS pacing mitigates PICM versus apical pacing, though stylet-driven leads underperform 3830 leads.
Why the study?
Pacing induced cardiomyopathy is a known complication of chronic right ventricular pacing, and recent data showed mitigation by superficial RV mid-septal pacing versus standard RV apical pacing in patients with normal left ventricular function.
Does superficial right ventricular mid-septal pacing with stylet-driven leads mitigate pacing-induced cardiomyopathy compared to 3830 leads or standard apical pacing?
Does superficial right ventricular mid-septal pacing with stylet-driven leads mitigate pacing-induced cardiomyopathy compared to 3830 leads or standard apical pacing?
While superficial right ventricular mid-septal pacing mitigates pacing-induced cardiomyopathy, stylet-driven leads appear to fail in duplicating the success achieved with 3830 leads.
Should not yet change pacing practices; hypothesis-generating for midseptal positioning and requires randomized confirmation.
Pacing induced cardiomyopathy (PICM) is an established potential complication of chronic right ventricular (RV) pacing therapy. We have recently demonstrated a significant mitigation of this complication by superficial RV mid-septal (RVMS) pacing in patients with normal left ventricular function, versus standard RV apical pacing.1 The designation of superficial is utilized to differentiate this approach from the deep septal approach utilized for left bundle branch area pacing (LBBAP). This data represented the first to demonstrate a clear improvement from apical pacing, despite attempts of multiple prior studies over 20 years.
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Kulkarni et al. (2025) conducted an editorial in Pacing-induced cardiomyopathy. Superficial right ventricular midseptal pacing vs. Standard RV apical pacing was evaluated. Superficial right ventricular midseptal pacing mitigates pacing-induced cardiomyopathy compared to standard RV apical pacing, though stylet-driven leads fail to duplicate 3830 success.
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