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Medium‐Term Effects of Septal and Apical Pacing in Pacemaker‐Dependent Patients: A Double‐Blind Prospective Randomized Study
Author(s) -
MOLINA LUIS,
SUTTON RICHARD,
GANDOY WILLIAM,
REYES NICOLÁS,
LARA SUSANO,
LIMÓN FROYLÁN,
GÓMEZ SUSANA,
ORIHUELA CONSUELO,
SALAME LATIFE,
MORENO GABRIELA
Publication year - 2014
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.12257
Subject(s) - medicine , ejection fraction , ventricle , qrs complex , cardiology , sinus rhythm , hemodynamics , atrioventricular block , implant , artificial cardiac pacemaker , randomized controlled trial , anesthesia , atrial fibrillation , heart failure , surgery
Background Pacing the right ventricle is established practice, but there remains controversy as to the optimal site to preserve hemodynamic function. Aims To evaluate clinical and hemodynamic differences between apical and septal pacing in pacemaker‐dependent patients. Methods Patients receiving their first pacemaker for advanced atrioventricular block, with the atria in sinus rhythm, were randomized to receive apical (Group A) or septal (Group S) ventricular leads. After implant, with the device programmed VVI 70 beats/min fixed rate, patients underwent a 6‐minute walk test and a transthoracic echocardiogram. Then, DDDR was programmed at nominal settings. The same tests were performed at 6 months and 12 months follow‐up. If ventricular pacing was less than 98%, the patient was excluded. Results A total of 142 patients were included in the study. During the study year, 71 (50%) were excluded for not fulfilling the condition of 98% ventricular pacing. Groups A and S had 34 and 37 patients, respectively. Age and gender were similar in the groups. At implant, QRS duration was significantly greater in Group A (158 ms) than Group S (146 ms; P = 0.018), and the QRS axis was different: –74.5° in Group A and 1° in Group S (P < 0.001). At 1 year, the 6‐minute walk improved significantly in both groups: Group A 15% (P = 0.048) and Group S 24% (P = 0.001). Left ventricular ejection fraction (LVEF) increased from 0.57 to 0.61 (P = 0.008) in Group S, without significant change in Group A. Conclusions After 1 year, pacemaker‐dependent patients with septal ventricular leads have better clinical and functional (LVEF) outcome.