“…It has been proposed that the adverse effects of RV pacing could be limited by choosing an alternative pacing site in the right ventricle. This led to the development of septal pacing which although promising in observational studies, did not avoid the hemodynamic effect of RV pacing [61], prevent adverse LV remodeling [62,63,64,65] or heart failure events [66] in randomized, controlled studies. These studies are further limited by not employing optimal RV pacing avoidance programming in either arm [9].…”