Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 May 15;9(5):3137-3146.
doi: 10.19102/icrm.2018.090501. eCollection 2018 May.

Right Ventricular Septal Pacing: A Paradigm Shift

Sarah A Worsnick  1 , Parikshit S Sharma  2 , Pugazhendhi Vijayaraman  1
Affiliations
Review

Right Ventricular Septal Pacing: A Paradigm Shift

Sarah A Worsnick et al. J Innov Card Rhythm Manag. .

Abstract

The right ventricular (RV) apex has been considered to be the primary site for ventricular lead implantation since the original descriptions of permanent pacing. However, long-term RV apical pacing has been shown to have negative effects on ventricular function and hemodynamics as a result of ventricular dyssynchrony. Alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for patients with a need for long-term ventricular pacing. In this article, we review the available data on the use of these alternative sites for RV pacing.

Keywords: His-bundle pacing; right ventricular apical pacing; right ventricular septal pacing.

PubMed Disclaimer

Conflict of interest statement

Dr. Vijayaraman reports that he is a speaker and consultant for Medtronic and on the advisory board for Boston Scientific. Dr. Sharma reports that he is a speaker and consultant for Medtronic and a consultant for St. Jude Medical, now Abbott Laboratories. Ms. Worsnick reports no conflicts of interest for the published content.

Figures

Figure 1:
Figure 1:
RV anatomy and a summary of RV pacing sites. Figure reproduced from the Netter Collection of Medical Illustrations with permission from Elsevier, Inc.
Figure 2:
Figure 2:
A: A 12-lead ECG with atrial and RV low septal pacing; QRS duration (QRSd): 150 ms. Note the Q wave in leads I and aVL. B: A posterioanterior view of the right atrial and septal RV leads on chest X-ray. C: A lateral view of the right atrial and septal RV leads. D: Schematic representation of the stylet shape showing the primary and secondary curves. E: Foreshortened view of the stylet shape demonstrating the secondary curve.
Figure 3:
Figure 3:
A: A 12-lead ECG during RV apical pacing; QRSd: 160 ms. Note the positive R-waves in leads I and aVL and the QS complexes in the chest leads. B: A posteroanterior chest X-ray of the right atrial and RV apical leads. C: A lateral chest X-ray of the right atrial and RV apical leads.
Figure 4:
Figure 4:
A: A 12-lead ECG with atrial and selective His-bundle pacing; QRSd: 90 ms. Note the normal-appearing QRS complexes with no T-wave changes. B: A posteroanterior chest X-ray of the right atrial and His-bundle pacing leads. C: A lateral chest X-ray of the right atrial and His-bundle pacing leads. HBP: His-bundle pacing.
See this image and copyright information in PMC

References

    1. Tracy CM, Epstein AE, Darbar D, et al. 2012 ACCF/AHA/HRS focused update of the 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60(14):1297–1313. [CrossRef] [PubMed] - DOI - PubMed
    1. Zou C, Song J, Li H, et al. Right ventricular outflow tract septal pacing is superior to right ventricular apical pacing. J Am Heart Assoc. 2015;4(4):pii:e001777. [CrossRef] [PubMed] - DOI - PMC - PubMed
    1. Chen K, Mao Y, Liu SH, et al. Is right ventricular midseptal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function? J Zhejiang Univ Sci B. 2014;15(6):507–514. [CrossRef] [PubMed] - DOI - PMC - PubMed
    1. Tops LF, Schalij MJ, Bax JJ. The effects of right ventricular apical pacing on ventricular function and dyssynchrony: implications for therapy. J Am Coll Cardiol. 2009;54(9):764–776. [CrossRef] [PubMed] - DOI - PubMed
    1. Lamas GA, Lee KL, Sweeney MO, et al. Ventricular pacing or dual-chamber pacing for sinus-node dysfunction. N Engl J Med. 2002;346(24):1854–1862. [CrossRef] [PubMed] - DOI - PubMed

LinkOut - more resources