- 作者：Giulia Domenichini ; Henri Sunthorn ; Eric Fleury ; Huberdine Foulkes ; Carine Stettler ; Haran Burri
- 关键词：Cardiac pacing ; Right ventricular apex ; Ventricular septum ; Left ventricular function ; Right ventricular function
- 刊名：European Journal of Internal Medicine
- 出版年：2012
- 出版时间：October, 2012
- 年：2012
- 卷：23
- 期：7
- 页码：621-627
- 全文大小：453 K
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 ¡À 8 % vs. 46 ¡À 15 % (p = 0.021) at 1 year and 53 ¡À 12 % vs. 47 ¡À 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 ¡À 7.7 % , p = 0.003 at 1 year and ? 8.0 ¡À 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.