Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

Abstract

Abstract:Objective: We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Methods: Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results: Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions: RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

The Effect of Right Ventricular Apical and Nonapical Pacing on the Short‐ and Long‐Term Changes in Left Ventricular Ejection Fraction: A Systematic Review and Meta‐Analysis of Randomized‐Controlled Trials

“…Thirteen studies included mainly Caucasian populations; eight were conducted exclusively in Asian individuals and one each in Mexico, Iran, and Argentina . Inclusion criteria included chronic high‐degree AV block, post‐AV node ablation, symptomatic sick sinus syndrome, and chronic atrial tachyarrhythmia and bradyarrhythmias . Fifteen studies (17 data sets) documented LVEF as an inclusion criterion (Table ) .…”

“…Inclusion criteria included chronic high‐degree AV block, post‐AV node ablation, symptomatic sick sinus syndrome, and chronic atrial tachyarrhythmia and bradyarrhythmias . Fifteen studies (17 data sets) documented LVEF as an inclusion criterion (Table ) . Six studies (six data sets) had an inclusion criterion specifically for patients with ejection fraction less than 40% .…”

“…Fifteen studies (17 data sets) documented LVEF as an inclusion criterion (Table ) . Six studies (six data sets) had an inclusion criterion specifically for patients with ejection fraction less than 40% . The LVEF was reported at baseline in both groups in 19 studies (21 data sets), and omitted in five studies (five data sets) .…”

“…Since the last meta‐analysis, there have been a number of further publications, including a large randomized trial and a number of smaller trials . As a result, we have undertaken this review to address the issues discussed above by providing further analyses that we feel deal specifically with the heterogeneity across studies.…”

Right Ventricular Septal Pacing: A Paradigm Shift

“…1,2 However, long-term RV apical (RVA) pacing has been shown to have negative effects on ventricular function and hemodynamics as a result of ventricular dyssynchrony. 3 In the last decade (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010), more data have emerged on the association of RVA pacing and left ventricular (LV) systolic dysfunction, heart failure (HF), ventricular remodeling, atrial fibrillation (AF), and increased mortality. 4 Alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for use in patients with a need for long-term ventricular pacing.…”