Right ventricular high septal pacing resulted in a smaller reduction in left ventricular ejection fraction (53% to 49%) compared to right ventricular apical pacing (56% to 43%) over 21 months.
Cohort (n=299)
Does permanent high interventricular septal pacing prevent left ventricular dysfunction and improve functional outcomes compared to right ventricular apical pacing in patients requiring pacemakers?
Right ventricular high septal pacing is a safe and effective alternative to conventional right ventricular apical pacing that better preserves left ventricular ejection fraction over long-term follow-up.
Absolute Event Rate: 49% vs 43%
AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. METHODS: We retrospectively evaluated: (1) 244 patients (74 ± 8 years; 169 men, 75 women) implanted with a single (132 pts) or dual chamber (112 pts) pacemaker (PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site (SEPTAL pacing); (2) 22 patients with permanent pacemaker and low percentage of pacing ( 80%) right ventricular apical pacing (RVA). All patients had a narrow spontaneous QRS (101 ± 14 ms). We evaluated New York Heart Association (NYHA) class, quality of life (QoL), 6 min walking test (6MWT) and left ventricular function (end-diastolic volume, LV-EDV; end-systolic volume, LV-ESV; ejection fraction, LV-EF) with 2D-echocardiography. RESULTS: Pacing parameters were stable during follow up (21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, QoL score and 6MWT. While LV-EDV didn't significantly increase (104 ± 40 mL vs 100 ± 37 mL; P = 0.35), LV-ESV slightly increased (55 ± 31 mL vs 49 ± 27 mL; P = 0.05) and LV-EF slightly decreased (49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF (from 56% ± 6% to 43% ± 9%, P < 0.0001). CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.
Occhetta et al. (Thu,) conducted a cohort in Patients requiring permanent pacemaker (n=299). Right ventricular high septal parahisian pacing vs. Right ventricular apical pacing and low percentage pacing was evaluated on Left ventricular ejection fraction (LV-EF). Right ventricular high septal pacing resulted in a smaller reduction in left ventricular ejection fraction (53% to 49%) compared to right ventricular apical pacing (56% to 43%) over 21 months.