Pacing of the interventricular septum versus the right ventricular apex: a prospective, randomized study

Autor: Huberdine Foulkes, Haran Burri, Henri Sunthorn, Eric Fleury, Giulia Domenichini, Carine Stettler
Rok vydání: 2012
Předmět:
Male
medicine.medical_specialty
Heart Ventricles
Ventricular Septum
Sick Sinus Syndrome/therapy
Ventricular Dysfunction
Left/etiology/radionuclide imaging
Ventricular Function
Left
Heart Ventricles/physiopathology
Random Allocation
Ventricular Dysfunction
Left
Radionuclide angiography
Internal medicine
Atrioventricular Block/therapy
Internal Medicine
medicine
Bradycardia
Humans
Single-Blind Method
cardiovascular diseases
Interventricular septum
Prospective Studies
Radionuclide Angiography
Lead (electronics)
Prospective cohort study
Atrioventricular Block
Cardiac Pacing
Artificial/adverse effects/methods
Aged
ddc:616
Aged
80 and over
Sick Sinus Syndrome
Ejection fraction
medicine.diagnostic_test
Ventricular function
business.industry
Cardiac Pacing
Artificial
Stroke Volume
Stroke volume
Surgery
Apex (geometry)
medicine.anatomical_structure
cardiovascular system
Cardiology
Female
business
Bradycardia/therapy
Zdroj: European Journal of Internal Medicine, Vol. 23, No 7 (2012) pp. 621-627
ISSN: 1879-0828
0953-6205
Popis: Background Left ventricular (LV) function may be impaired by right ventricular (RV) apical pacing. The interventricular septum is an alternative pacing site, but randomized data are limited. Our aim was to compare ejection fraction (EF) resulting from pacing the interventricular septum versus the RV apex. Methods RV lead implantation was randomized to the apex or the mid-septum. LVEF and RVEF were determined at baseline and after 1 and 4 years by radionuclide angiography. Results We enrolled 59 patients, of whom 28 were randomized to the apical group and 31 to the septal group, with follow-up available in 47 patients at 1 year and 33 patients at 4 years. LVEF in the apical and in the septal groups was 55 ± 8% vs. 46 ± 15% (p = 0.021) at 1 year and 53 ± 12% vs. 47 ± 15% (p = 0.20) at 4 years. Echocardiography confirmed a mid-septal lead position in only 54% of patients in the septal group, with an anterior position in the remaining patients. In the septal group, LVEF decreased significantly in patients with an anterior RV lead (− 10.0 ± 7.7%, p = 0.003 at 1 year and − 8.0 ± 9.5%, p = 0.035 at 4 years), but not in patients who had a mid-septal lead. Left intraventricular dyssynchrony was significantly increased in case of an anterior RV lead. RVEF was not significantly impaired by RV pacing, regardless of RV lead position. Conclusions Pacing at the RV septum confers no advantage in terms of ventricular function compared to the apex. Furthermore, inadvertent placement of the RV lead in an anterior position instead of the mid-septum results in reduced LV function.
Databáze: OpenAIRE
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