Comparison of Right Ventricular Outflow Tract and Apical Lead Permanent Pacing on Cardiac Output

Optimizing the pacing site in the ventricular septum by fluoroscopy and morphology of the paced QRS complex

“…Most short-term studies found significant differences in hemodynamic parameters in favor of the RVOT (ref. [5][6][7] ). Some studies, however, reported only insignificant positive hemodynamic changes 8,9 and also insignificant differences in functional performance in favor of the RVOT (ref.…”

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

“…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).…”

“…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).…”

“…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). Many previous studies (Schwaab et al, 1999;Victor et al, 2006;Yu et al, 2007;Ng et al, 2009;Takemoto et al, 2009;Tse et al, Europace 2009, Gong et al, 2009Leong et al, 2010;Schwaab et al, 2001), have showed that septal pacing induced shorter paced QRS duration than RVA pacing did.…”

“…Results from acute and chronic studies are summarized in table 1 and show mixed results with a tendency toward better hemodynamic outcome when pacing at these alternative sites (Giudici et al, 1997;Kolettis et al, 2000;Tse et al, 2002;Yu et al, 2007;Flevari et al, 2009;Takemoto et al, 2009;Yoshikawa et al, 2010;Yu et al, 2009;de Cock et al, 2003). AF: atrial fibrillation; AV : atrioventricular; AVNA: AV node ablation; AVB: atrioventricular block; DDD: dual chamber pacing; HRA: high right atrium ; NA: not available; PSP: Peak systolic pressure; RVS: right ventricle septum; RVOT: right ventricle outflow tract; RVA: right ventricle apex; SSS: sick sinus syndrome; VA: ventricular asynchrony; VRR : ventricular rate regularization; VVI: single chamber ventricular pacing; * the study population included only children; § LVEF ≤45% in 12 patients; ¥ LVEF <40% in 14% of patients; ¤ LVEF<40% in 1 patient.…”