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

William Eysenck; Neil Sulke; Angela Gallagher; Fadi Jouhra; Nikhil Patel; Stephen Furniss; Rick Veasey

International Cardiovascular Research Journal

The Official Annually Journal of Cardiovascular Research Center, Shiraz University of Medical Sciences

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

Author(s):

William Eysenck^1,*,

Neil Sulke¹,

Angela Gallagher¹,

Fadi Jouhra¹,

Nikhil Patel¹,

Stephen Furniss¹,

Rick Veasey¹

1Cardiology Research Department, Eastbourne General Hospital, East Sussex, United Kingdom

International Cardiovascular Research Journal:Vol. 12, issue 3; e69785

Published online:Sep 01, 2018

Article type:Research Article

Received:Aug 29, 2018

Accepted:Jul 01, 2018

How to Cite:William EysenckNeil SulkeAngela GallagherFadi JouhraNikhil PatelStephen FurnissRick Veaseyet al.Right Ventricular Septal Pacing vs. Right Ventricular Apical Pacing Following Atrioventricular Node Ablation: A 10-Year Follow-up.Int Cardiovasc Res J.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.

Keywords

Heart Failure

Heart Ventricles

Ablation

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