Comparison of Effectiveness of Right Ventricular Septal Pacing Versus Right Ventricular Apical Pacing

Permanent Cardiac Pacing in Adults with High Grade Atriovetricular Block and Preserved Left Ventricular Function: Optimal Mode and Site of Pacing

“…The RV septal pacing also resulted in shorter isovolumic relaxation than RV apical pacing (Yu et al, 2007), implicating better diastolic function that has been invasively demonstrated by Kolettis et al (Kolettis et al, 2000) at the cardiac catheterization laboratory. In fact despite the beneficial features of reducing electrical and mechanical dyssynchrony , different studies failed to demonstrate a positive effect on indices of LV structure and 85 function and did not confirm the above mentioned clinical outcomes, at least during the 3-18 months after implantation (Bourke et al, 2002;Victor et al, 2006;Kypta et al, 2008;Dabrowska-Kugacka et al, 2009;Gong et al, 2009;Cano et al, 2010) Kypta et al (Kypta et al, 2008) randomized 98 patients with atrioventricular block (AVblock) undergoing pacemaker implantation to positioning the ventricular lead in the high or mid septum (n =53) or in the apex (n = 45) of the right ventricle. The Changes of N-terminal pro-brain natriuetic peptide (BNP) levels, LVEF, and exercise capacity from baseline to 18 months were statistically not different between septal and apical stimulation.…”

“…Sweeney et al (Sweeney et al, 2003) showed that in patients with normal LV systolic function without myocardial infarction, the risk of heart failure after RVA pacing was low. So RVA pacing may do little harm to patients with normal LV systolic function and RVOT pacing may have no benefit over RVA pacing for these patients (Cano et al, 2010). In patients with normal LV systolic function, ventricular synchrony may be of less importance and of more time needed for pacing-induced ventricular remodeling in that population.…”

“…Many recent studies have compared the mechanic synchrony between septal pacing and RVA pacing (Schwaab et al, 1999;Yu et al, 2007;Flevari et al, 2009;Ng et al, 2009;Takemoto et al, 2009;Leong et al, 2010;Cano et al, 2010;Yoshikawa et al, 2010) and have showed a more inter and intraventricular synchrony with septal pacing than apical pacing immediately after implantation and at midterm (after 6 to 12 months of follow-up), excepted for the study of Ng et al (Ng et al, 2009). Moreover, patients in the RVAP group had significantly more inter and intraventricular dyssynchrony than did the controls, and patients in the RVSP group had comparable values to those obtained from the control group (Flevari et al, 2009;Verma et al, 2010;Cano et al, 2010). In contrast; Takemoto et al (Takemoto et al, 2009) have revealed that, RVS pacing caused a significant increase in the interventricular mechanical delay (IVMD) compared with AAI pacing, which indicates that the onset of the LV activation is delayed even during RVS pacing.…”

“…A pacing site that is in closer proximity with the proximal portion of His bundle at the RV septum should lead to a narrower QRS which in turn might reflect a lesser degree of activation delay compared with RVA pacing (Mera et al, 199;Schwaab et al, 1999;Tse et al, 2002) and less dyssynchrony, as demonstrated by multiple echocardiographic techniques (Tse et, 2002;Flevari et al, 2009;Takemoto et al, 2009;Gong et al, 2009;Leong et al, 2010;Cano et al, 2010). Pacing on the right ventricular (RV) septum, at high (septal RVOT pacing) (Giudici et al, 1997;Kolettis et al, 2000;Bourke et al, 2002;Tse et al, 2002;Dabrowska-Kugacka et al, 2009;Gong et al, 2009;Leong et al, 2010;Yoshikawa et al, 2010), mid (Yu et al, 2007;Cano et al, 2010;Muto et al, 2007) or lower (Flevari et al, 2009) septal pacing position has been introduced as a potentially favorable alternative to RVA pacing to preserve a more physiologic ventricular activation. Previous investigations of alternative pacing sites have yielded inconsistent results (Mera et al, 1999;Giudici et al, 1997;Bourke et al, 2002;Victor et al, 2006;Kypta et al, 2008;Dabrowska-Kugacka et al, 2009;Tse et al Europace 2009;Victor et al, 1999) which may be attributable, in part, to the fact that the pacing site was determined on a topological rather than functional basis (Giudici & Karpawich, 1999).…”

“…Right Ventricular Apical permanent pacing could have negative hemodynamic effects. Initially, attention was directed to RV outflow tract/septum pacing and His/para-Hisian pacing in patients with LV dysfunction ( Mera et al, 1999;Schwaab et al, 1999;Buckingham et al, 1997;Buckingham et al, 1998;de Cock et al, 1998) and latter in preserved LV function patients (Giudici et al, 1997;Karpawich & Mital, 1997;Kolettis et al, 2000;Bourke et al, 2002;Tse et al, 2002;Occhetta et al, 2006;Victor et al, 2006;Yu et al, 2007;Kypta et al, 2008;Flevari et al, 2009;Ng et al, 2009;Dabrowska-Kugacka et al, 2009;Takemoto et al, 2009;Gong et al, 2009;Rosso et al, 2010;Verma et al , 2010;106:806-9;Leong et al, 2010;Cano et al,. 2010;Yoshikawa et al, 2010) while subsequently biventricular stimulation began to emerge as an appealing alternative proposal (Yu et al, 2009;Simantirakis et al, 2009;Doshi et al, 2005).…”