Right Ventricular Septal Versus Apical Pacing: Long-Term Incidence of Heart Failure and Survival

Abstract

The clinical benefits of right ventricular septal (RVS) pacing compared to those of right ventricular apical (RVA) pacing are still in debate. We aimed to compare the incidence of heart failure (HF) and all-cause mortality in patients submitted to RVS and RVA pacing during a longer follow-up. This a single-center, retrospective study analysis of consecutive patients submitted to pacemaker implantation. The primary outcome was defined as the occurrence of HF during follow-up. The secondary outcome was all-cause death. A total of 251 patients were included, 47 (18.7%) with RVS pacing. RVS pacing was associated to younger age, male gender, lower body mass index, ischemic heart disease, and atrial fibrillation. During a follow-up period of 5.2 years, the primary outcome occurred in 89 (37.1%) patients. RVS pacing was independently associated with a 3-fold lower risk of HF, after adjustment. The secondary outcome occurred in 83 (34.2%) patients, and pacemaker lead position was not a predictor. Fluoroscopy time and rate of complications (rarely life-threatening) were similar in both groups. Our study points to a potential clinical benefit of RVS positioning, with a 3.3-fold lower risk of HF, without accompanying increase in procedure complexity nor complication rate.

Implantable Cardiac Devices in Patients with Brady- and Tachy-Arrhythmias: An Update of the Literature

“…Moreover, the results of the SEPTAL-PM trial found no difference in LVEF, quality of life scores and functional status between RVS pacing and RVAP at 18 months [ 11 ]. Only one study has reported a higher risk of heart failure events with RVAP, however this study included high numbers of patients with co-morbidities known to be associated with heart failure events, such as baseline LV impairment and AF, when compared to other studies [ 12 ]. As a result of this, current guidelines do not recommend the preferential use of either RVAP or RVS pacing over the other.…”