Document Detail


Pacing of the interventricular septum versus the right ventricular apex: A prospective, randomized study.
MedLine Citation:
PMID:  22939807     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
BACKGROUND: Left ventricular (LV) function may be impaired by right ventricular (RV) apical pacing. The interventricular septum is an alternative pacing site, but randomized data are limited. Our aim was to compare ejection fraction (EF) resulting from pacing the interventricular septum versus the RV apex.
METHODS: RV lead implantation was randomized to the apex or the mid-septum. LVEF and RVEF were determined at baseline and after 1 and 4years by radionuclide angiography.
RESULTS: We enrolled 59 patients, of whom 28 were randomized to the apical group and 31 to the septal group, with follow-up available in 47 patients at 1year and 33 patients at 4years. LVEF in the apical and in the septal groups was 55±8% vs. 46±15% (p=0.021) at 1year and 53±12% vs. 47±15% (p=0.20) at 4years. Echocardiography confirmed a mid-septal lead position in only 54% of patients in the septal group, with an anterior position in the remaining patients. In the septal group, LVEF decreased significantly in patients with an anterior RV lead (-10.0±7.7%, p=0.003 at 1year and -8.0±9.5%, p=0.035 at 4years), but not in patients who had a mid-septal lead. Left intraventricular dyssynchrony was significantly increased in case of an anterior RV lead. RVEF was not significantly impaired by RV pacing, regardless of RV lead position.
CONCLUSIONS: Pacing at the RV septum confers no advantage in terms of ventricular function compared to the apex. Furthermore, inadvertent placement of the RV lead in an anterior position instead of the mid-septum results in reduced LV function.
Authors:
Giulia Domenichini; Henri Sunthorn; Eric Fleury; Huberdine Foulkes; Carine Stettler; Haran Burri
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Publication Detail:
Type:  Journal Article     Date:  2012-04-11
Journal Detail:
Title:  European journal of internal medicine     Volume:  23     ISSN:  1879-0828     ISO Abbreviation:  Eur. J. Intern. Med.     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9003220     Medline TA:  Eur J Intern Med     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  621-7     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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