Effect of right ventricular pacing lead site on left ventricular function in patients with high-grade atrioventricular block: results of the Protect-Pace study

Abstract

ClinicalTrials.gov number NCT00461734.

Should All Patients With Heart Block Receive Biventricular Pacing?

“…However, true RV septal pacing and His bundle pacing are limited by the difficulty of achieving stable lead positions. 25,26 The most commonly used alternative site is the RV outflow tract, but there is as yet no randomized trial evidence that supports the superiority of this pacing site compared with RV apical pacing. 27 Biventricular pacing is a well-established therapy for HF patients with LV ejection fraction (LVEF) <35% and wide QRS complex duration.…”

Feasibility and Acute Hemodynamic Effect of Left Ventricular Septal Pacing by Transvenous Approach Through the Interventricular Septum

“…7 However, 3 randomized trials comparing RVS with RVA pacing in patients with congestive heart failure and chronic atrial fibrillation and patients with total AV block showed no differences in LV ejection fraction, quality of life, exercise capacity, and brain natriuretic peptide levels at longterm follow-up. 8,16,17 Previous acute hemodynamic studies in dogs with normal ventricular conduction have demonstrated that pacing at the LVS maintains LV systolic and diastolic function at sinus rhythm level, whereas LV function is depressed during RVA and RVS pacing. 10,11 The data from this study extrapolate these preclinical findings on the beneficial hemodynamic effect of LVS pacing to the human population.…”

“…Alternative pacing sites within the right ventricle (RV), such as the RV septum (RVS) or RV outflow tract, have been intensively studied but show mixed results. [7][8][9] Studies on animals have shown that pacing at the LV septum (LVS) yields LV pump function closely approximating that during normal ventricular conduction and significantly better than that during RVS pacing. 10,11 In the animal experiments, the LVS lead was permanently placed by introducing a custom pacing lead with extended helix transvenously into the RV and driving it from the RV side through the interventricular septum (IVS) to the LVS.…”

Optimal Pacing for Right Ventricular and Biventricular Devices

“…However, a benefit of high septal pacing on preservation of ventricular function or prevention of AF or HF events was not observed in the ProtectPace study, which randomized 240 patients with high-grade AV block to high septal or RV apical pacing. 38 It is now well established that pacing at the RV outflow tract or septal locations can be achieved with acceptable pacing thresholds and minimal risk of complications, including lead dislodgement, and this approach seems to be increasingly adapted into clinical practice. Although promising, pacing from sites in the His bundle region remains problematic with lower success rates, higher pacing thresholds, and longer procedure times.…”