Right ventricular septal pacing is recommended over apical pacing to prevent progressive left ventricular dysfunction, as active-fixation leads can now be reliably secured to the septum.
Does right ventricular septal pacing prevent left ventricular dysfunction compared to right ventricular apical pacing?
This review outlines the techniques and tools for RV septal pacing, advocating for its use over RV apical pacing to prevent pacing-induced left ventricular dysfunction.
Prolonged right ventricular (RV) apical pacing is associated with progressive left ventricular dysfunction due to dysynchronous ventricular activation and contraction. RV septal pacing allows a narrower QRS compared to RV apical pacing, which might reflect a more physiological and synchronous ventricular activation. Previous clinical studies, which did not consistently achieve RV septal pacing, were not confirmatory and need to be repeated. This review summarizes the anatomy of the RV septum, the radiographic appearances of pacing leads in the RV, the electrocardiograph correlates of RV septal lead positioning, and the techniques and tools required for implantation of an active-fixation lead onto the RV septum. Using the described techniques and tools, conventional active-fixation leads can now be reliably secured to either the RV outflow tract septum or mid-RV septum with very low complication rates and good long-term performance. Even though physiologic and hemodynamic studies on true RV septal pacing have not been completed, the detrimental effects of long-term RV apical pacing are significant enough to suggest that it is now time to leave the RV apex and secure all RV leads onto the septum.
Harry G. Mond (Mon,) conducted a review in Right ventricular pacing. Right ventricular septal pacing vs. Right ventricular apical pacing was evaluated. Right ventricular septal pacing is recommended over apical pacing to prevent progressive left ventricular dysfunction, as active-fixation leads can now be reliably secured to the septum.