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Randomized Controlled Trial
. 2014 Jun;15(6):507-14.
doi: 10.1631/jzus.B1400034.

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

Kang Chen  1 , Ye Mao, Shao-hua Liu, Qiong Wu, Qing-zhi Luo, Wen-qi Pan, Qi Jin, Ning Zhang, Tian-you Ling, Ying Chen, Gang Gu, Wei-feng Shen, Li-qun Wu
Affiliations
Randomized Controlled Trial

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

Kang Chen et al. J Zhejiang Univ Sci B. 2014 Jun.

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%.

Keywords: Apical pacing; Impaired heart function; Mid-septal pacing.

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Conflict of interest statement

Compliance with ethics guidelines: Kang CHEN, Ye MAO, Shao-hua LIU, Qiong WU, Qing-zhi LUO, Wen-qi PAN, Qi JIN, Ning ZHANG, Tian-you LING, Ying CHEN, Gang GU, Wei-feng SHEN, and Li-qun WU declare that they have no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for which identifying information is included in this article.

Figures

Fig. 1
Fig. 1
Radiological anatomy of mid-septum access (a) 40° left anterior oblique (LAO) fluoroscopy with the lead in septal position. The tip of the lead is geared for the column, in a direction opposite to the freewall of the right ventricle (RV). (b) Septal position is represented in the 10° right anterior oblique (RAO) fluoroscopy. The letter A (white circle) represents the middle portion of the interventricular septum. The letter B (black circle) represents the high septal region and the letter C (black circle) the tip of RV. The figures are reproduced with permission from Lieberman et al. (2004)
Fig. 2
Fig. 2
BNP (a), 6MWT (b), and LVEF (c) at baseline and during follow-up in patients with 35%P<0.05); (b) 6WMT shows a significant increase in patients with 35%<LVEF≤40% allocated to the RVMSP group compared with the RVAP group after 18 months’ follow-up (P<0.05); (c) After 18 months’ follow-up, patients with 35%<LVEF≤40% at baseline allocated to RVMSP have a significant increase compared with RVAP (P<0.05). Data are expressed as mean±SD
Fig. 3
Fig. 3
BNP at low and high LVEF groups within mid-septal pacing Different levels of LVEF appear to be a key factor for the therapy of mid-septal pacing. The lower LVEF (35%P<0.05). * P>0.05, ** P<0.05, vs. baseline. Data are expressed as mean±SD
See this image and copyright information in PMC

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