Related Experiment Videos
The right ventricular outflow tract as an alternative permanent pacing site: long-term follow-up
E S Barin1, S M Jones, D E Ward
1Department of Cardiology, St. Bartholomew's Hospital, London, England.
Insights
The right ventricular outflow tract is a suitable alternative to the right ventricular apex for permanent pacemaker implantation. Long-term pacing characteristics and acute measurements were comparable between both sites, indicating high satisfaction.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Permanent pacing is crucial for managing bradyarrhythmias.
- The right ventricular apex has been the traditional site for ventricular pacing.
- Alternative pacing sites are being explored to optimize long-term pacing outcomes.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of the right ventricular outflow tract as a permanent pacing site.
- To compare the right ventricular outflow tract pacing with the conventional right ventricular apex pacing.
Main Methods:
- A randomized study involving 33 patients requiring ventricular pacing.
- Pacing leads were implanted using a screw-in technique.
- Programmable pacemakers were used for threshold testing and follow-up.
Main Results:
- No significant difference in lead positioning time or acute implant measurements between the two sites.
- Comparable chronic pacing thresholds at a mean follow-up of 73 months.
- One lead dislodgement complication occurred at the outflow tract site in a pacemaker twiddler.
Conclusions:
- The right ventricular outflow tract is a safe and effective alternative permanent pacing site.
- Both right ventricular outflow tract and right ventricular apex pacing demonstrate satisfactory long-term characteristics.
- Further research may explore patient selection for optimal lead placement.
Abstract:
The long-term characteristics of the right ventricular outflow tract have been assessed as an alternative permanent pacing site to the right ventricular apex. Thirty-three consecutive patients requiring ventricular pacing were randomized to be paced from one of the two sites. Pacing was performed using a screw-in lead, and a programmable pacemaker was used to facilitate threshold testing. There was no significant difference in the lead positioning time or any acute implant measurement (e.g., threshold at 0.5 msec 0.4 +/- 0.2 V for both sites, P = 0.99). Chronic measurements were also comparable during follow-up (mean 73 months) with a mean threshold at most recent follow-up of 0.15 +/- 0.2 msec (apex) and 0.13 +/- 0.21 msec (outflow tract) at 5 V, P = 0.81. There was only one pacing related complication, a lead dislodgment (outflow tract) in a pacemaker twiddler. Overall, both sites were highly satisfactory.