Right Ventricular Septal Pacing vs. Right Ventricular Apical Pacing Following Atrioventricular Node Ablation: A 10-Year Follow-up

authors:

avatar William Eysenck 1 , * , avatar Neil Sulke 1 , avatar Angela Gallagher 1 , avatar Fadi Jouhra 1 , avatar Nikhil Patel 1 , avatar Stephen Furniss 1 , avatar Rick Veasey 1

Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom
International Cardiovascular Research Journal: Vol.12, issue 3; e69785
published online: September 01, 2018
article type: Research Article
received: August 29, 2018
accepted: July 01, 2018

how to cite: Eysenck W, Sulke N, Gallagher A, Jouhra F, Patel N, et al. Right Ventricular Septal Pacing vs. Right Ventricular Apical Pacing Following Atrioventricular Node Ablation: A 10-Year Follow-up. Int Cardiovasc Res J. 2018;12(3):e69785. 

Abstract

Background:

Right Ventricular Septal (RVS) pacing is often recommended as a more physiological alternative to Right Ventricular Apical (RVA) pacing.

Objectives:

This study aimed to determine the long-term outcomes in patients persistently paced following Atrioventricular Node (AVN) ablation.

Materials and Methods:

This study was conducted on 200 patients who underwent Permanent Pacemaker (PPM) implantation prior to AVN ablation with either RVA- or RVS-pacing. Primary endpoints were hospitalization due to Heart Failure (HF) and death. Secondary endpoints included changes in Ejection Fraction (EF), inter- and intra-ventricular dyssynchrony measures, and paced QRS duration. Demographic data were obtained from all patients. In addition, CT chest examinations were analyzed to confirm RVS lead position.

Results:

The mean survival time from AVN ablation was 6.32 ± 4.294 years in the RVA group and 3.00 ± 2.546 years in the RVS group (hazard ratio = 3.512, P = 0.0001). The results showed no significant differences between the two sites regarding hospitalization due to HF. Baseline and follow-up EFs were respectively 48.4 ± 13.8% and 53.1 ± 8.5% for RVA pacing and 52.0 ± 10.6% and 55.2 ± 11.3% for RVS pacing (P = 0.911). Moreover, 76% of the patients in the RVS group had a septal lead confirmed on CT chest review. Twenty-four percent of the RVS leads were in alternate sites, including the RVA and free wall.

Conclusions:

The results revealed was no diminution in EF with either lead position at long-term follow-up. The mortality rate was significantly less in RVA pacing compared to documented septal pacing although a quarter of the RVS leads were found in alternate sites on CT chest review.

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References

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