What is the clinical evidence from this study?

Study design: Cohort. Population: Permanent right ventricular apical pacing requiring device replacement (n=24). Intervention: Right ventricular septal pacing upgrade vs. Continued right ventricular apical pacing. Primary outcome: Changes in left ventricular performance and functional capacity.

April 10, 2009

Upgrading Pacemaker Patients with Right Ventricular Apical Pacing to Right Ventricular Septal Pacing Improves Left Ventricular Performance and Functional Capacity

Key Result

Upgrading from right ventricular apical to septal pacing significantly improved left ventricular ejection fraction (55.2% to 60.4%, P=0.0002) and 6-minute walk distance (308.2m to 355.5m, P=0.015).

Study Design

Type

Cohort (n=24)

Structured PICO

Does upgrading to RV septal pacing improve LV performance and functional capacity in patients with previously permanent RV apical pacing?

Population

24 patients with previously permanent right ventricular (RV) apical pacing requiring device replacement

Intervention

Upgrading to RV septal pacing at the time of device replacement

Comparator

Continued RV apical pacing

Outcome

Changes in left ventricular (LV) performance (LV ejection fraction, peak ventricular filling rate) and functional capacity (6-minute hallwalk test) at 18 monthssurrogate

Upgrading from RV apical to RV septal pacing at the time of device replacement can reverse deleterious effects on LV systolic and diastolic function and improve functional capacity.

Abstract

BACKGROUND: Right ventricular (RV) apical pacing results in abnormal left ventricular (LV) electrical and mechanical activation and is associated with an increased risk of developing heart failure. Chronic RV septal pacing has been shown to be superior to RV apical pacing in newly implanted patients. However, whether RV septal pacing can reverse deleterious effects of RV apical pacing remain unclear. METHODS: We evaluated the effects of RV septal pacing on LV performance and functional capacity before and at 18 months after device replacement in 12 patients with previously permanent RV apical pacing and in 12 control patients that continued RV apical pacing. All patients underwent radionuclide ventriculography and 6-minute hallwalk (6-MHW) test before replacement (baseline) and at 18 months afterward to determine changes in LV performance and functional capacity, respectively. RESULTS: After RV septal upgraded, there was a significant decrease in paced QRS duration (171.2 +/- 3.9 ms to 160.4 +/- 3.5 ms, P = 0.0016), increase in LV ejection fraction (55.2 +/- 2.6% vs 60.4 +/- 2.9%, P = 0.0002), the peak ventricular filling rate (2.60 +/- 0.13 s(-1) vs 3.01 +/- 0.14 s(-1), P = 0.046), and 6-MHW (308.2 +/- 31.6 m vs 355.5 +/- 34.2 m, P = 0.015) at 18 months compared with baseline. No changes in these parameters were observed in the control group (P > 0.05). CONCLUSION: RV septal pacing upgraded improves LV systolic and diastolic function and functional capacity in patients with previously permanent RV apical pacing. These findings suggest that RV septal pacing can reverse the deleterious effects of RV apical pacing in patients who required permanent ventricular pacing.

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