Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing

• Published in: Europace (London, England) Vol. 10; no. 5; pp. 574 - 579
• Main Authors: Kypta, Alexander, Steinwender, Clemens, Kammler, Jürgen, Leisch, Franz, Hofmann, Robert
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01-05-2008; Oxford Publishing Limited (England)
• Subjects: Atrioventricular Block - diagnosis; Atrioventricular Block - prevention & control; Cardiac Pacing, Artificial - methods; Electrodes, Implanted; Female; Heart Septum; Heart Ventricles; Humans; Longitudinal Studies; Male; Prosthesis Implantation - methods; Treatment Outcome; Septal pacing; Ventricular function; Congestive heart failure; Apical pacing
• ISSN: 1099-5129; 1532-2092
• DOI: 10.1093/europace/eun085

Aims
Left ventricular function may be altered by right ventricular apical pacing. The aims of the study were to compare the long-term course of different parameters of left ventricular dysfunction in patients undergoing implantation of a dual-chamber pacemaker with the ventricular lead in a septal position vs. in a standard apical position.
Methods
We randomized 98 patients with atrioventricular block (AV-block) undergoing pacemaker implantation to positioning the ventricular lead in the high or mid septum (n = 53) or in the apex (n = 45) of the right ventricle. N-terminal pro-brain natriuetic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and exercise capacity were analysed 3 days, 3 months, and 18 months after the implantation. The primary endpoints were the changes of these parameters from baseline to 18 months.
Results
Changes of BNP levels, LVEF, and exercise capacity from baseline to 18 months were statistically not different between septal and apical stimulation. The clinical occurrence or deterioration of overt heart failure was similar in both treatment arms.
Conclusion
With regard to different parameters of congestive heart failure, a septal stimulation site is not superior to conventional apical pacing in unselected patients undergoing pacemaker implantation for AV-block.