Effect of Pacing the Right Ventricular Mid‐Septum Tract in Patients with Permanent Atrial Fibrillation and Low Ejection Fraction

Muto, Carmine; Ottaviano, Luca; Canciello, Michelangelo; Carreras, Giovanni; Calvanese, Raimondo; Ascione, Luigi; Iengo, Raffaele; Accadia, Maria; Celentano, E.; Tuccillo, Bernardino

doi:10.1111/j.1540-8167.2007.00914.x

Cited by 42 publications

(33 citation statements)

References 33 publications

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“…Furthermore, using this procedure, we achieved an extremely narrow pacing QRS width in lead II of the 12-lead electrocardiogram, as shown in this study. Compared to the QRS width for RV outflow tract pacing described in several reports, 20,21) the QRS width for RV mid-septal pacing was shown to be obviously narrower. Narrowing of QRS width suggests a reduction in the time for ventricular conduction and easier preservation of ventricular synchrony.…”

Section: Discussionmentioning

confidence: 99%

Selective Site Pacing From the Right Ventricular Mid-Septum

et al. 2012

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SummaryPacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied. A screw-in lead and a curved stylet were used for lead positioning on the RV mid-septum. Pacemaker indices were evaluated at implantation and one year later. As an electrocardiographic parameter, QRS duration was measured in lead II. These data were compared to those of 66 patients subjected to conventional RV apical pacing. Lead placement was successful in all patients of RV mid-septal pacing. There were no technical problems during or after the procedure. The cumulative percentage of ventricular pacing at one year postimplantation was 85 ± 24 % in the SSP group. Sensing, pacing threshold, and lead impedance in the SSP group remained clinically stable over one year. When these measurements were compared between the SSP and AP groups, the pacing threshold and the lead impedance at one year postimplantation in the SSP group were higher (P < 0.05) and lower (P < 0.01), respectively, than those of the AP group. The mean QRS duration was markedly shorter (123 ± 16 versus 150 ± 18 msec, P < 0.0001). Selective site pacing from the RV mid-septum is feasible and results in less conduction delay compared to conventional RV apical pacing, and its procedure seems to be more physiological in permanent pacemaker implantation. (Int Heart J 2012; 53: 113-116) Key words: Pacing procedure, Selective site pacing, Physiological pacing, Right ventricular mid-septal pacing, Pacemaker implantation T he mainstream of pacing treatment for bradyarrhythmia has been pacing from the right ventricular (RV) apex, which has been regarded as physiological pacing, to maintain atrioventricular synchrony. However, with conventional RV apex pacing, the impulse is conducted from the apex to the base of the heart and from the right to the left ventricles, and therefore the time for impulse conduction in the ventricles is significantly prolonged.1,2) This procedure is reported to cause ventricular dyssynchrony, 3,4) resulting in an increased risk for occurrence of heart failure 5-7) or atrial fibrillation. 7,8) Recently, selective site pacing (SSP), where alternate sites for ventricular pacing are used, has come into use to improve ventricular dyssynchrony. 9-11)In SSP, His-bundle or para-His pacing 12,13) and a procedure where a ventricular lead is positioned in the RV outflow tract have been used.14-16) The former involves technical difficulties, whereas the latter has produced unsatisfactory longterm effects and also poses a high risk of complications such as pericardial effusion. 17)In this study, we evaluated the efficacy and safety of SSP in patients in whom RV leads were positioned in the middle of the RV septum (mid-septum) and compared it with conventional RV apex pacing. We also examined points to obtain f...

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Section: Discussionmentioning

confidence: 99%

Selective Site Pacing From the Right Ventricular Mid-Septum

et al. 2012

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“…In randomized studies, right ventricular nonoutflow septal pacing was compared with RVA pacing. According to LV echocardiographic parameters, the published results documented both the short-and long-term superiority of mid-septal pacing [14][15][16] . More definitive evidence of the potential benefits of pacing from various precisely defined septal sites over RVA is provided by the results of three randomized prospective multicenter studies -Optimize RV, Protect Pace, RASP -that are currently underway.…”

Section: Introductionmentioning

confidence: 98%

“…With Hisbundle pacing, a short paced QRS complex is recorded and interventricular dyssynchrony is not induced 21 . In earlier studies, the QRS duration was used as a criterion for selecting the optimal pacing site in the RV septum, with a confirmed hemodynamic benefit compared with RVA pacing 3,7,15 . Given this evidence and easy quantification of the parameter, paced QRS duration was selected as the only parameter of the optimal RV pacing site in this study.…”

Section: Justification Of Paced Qrs Duration As a Parameter Of The Opmentioning

confidence: 99%

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

Kameník¹,

Sedloň²,

Hnátek³

et al. 2013

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aims. To analyze the paced QRS duration in various septal positions of the right ventricular leads and with different paced QRS vectors. To use the results to assess parameters suggesting the optimal site for right ventricular pacing. Methods and Results. A total of 609 patients with leads implanted in the right ventricular septum were classified using fluoroscopy in the lateral view (the primary pacing site), and in the anteroposterior view (the secondary pacing site), according to the QRS vector in leads I and III. Significantly shortened paced QRS was found in the primary pacing site with the true septal compared with the anteroseptal site, with the vector being negative or isoelectric in lead I plus positive in lead III. In secondary pacing sites, no significant difference in pacing QRS duration was found between RVOT-HS, RVOT-LS, mid-septum and inferior-septum. Conclusions. For optimization of the pacing site in the ventricular septum, the following are significant: the primary site based on the lateral view, and the paced QRS vector in leads I and III.

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“…A positive and statistically significant correlation was found between the paced QRS duration and global dyssynchrony (Victor et al, 2006;Flevari et al 2009;Takemoto et al, 2009;Muto et al, 2007). However, it has been shown in experimental studies that RV pacing sites maintaining an optimal LV function, are not correlated with the narrowest paced QRS complexes (Peschar et al, 2003).…”

Section: Electric and Mechanic LV Synchronymentioning

confidence: 86%

“…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).…”

Section: Electric and Mechanic LV Synchronymentioning

confidence: 99%

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

Ouali¹

2011

Cardiac Pacemakers - Biological Aspects, Clinical Applications and Possible Complications

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Effect of Pacing the Right Ventricular Mid‐Septum Tract in Patients with Permanent Atrial Fibrillation and Low Ejection Fraction

Abstract: The present study suggests that more physiological pacing from the RV sept can improve EF and quality of life (QoL) in patients with permanent AF and low EF needing a PM.

Cited by 42 publications

References 33 publications

Selective Site Pacing From the Right Ventricular Mid-Septum

Selective Site Pacing From the Right Ventricular Mid-Septum

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

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

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