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Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared
Alexander Kypta1, Clemens Steinwender, Jürgen Kammler
1First Department of Internal Medicine, Cardiovascular Division, Academic Teaching and General Hospital Linz, Krankenhausstrasse 9, A-4020 Linz, Austria.
Insights
Septal pacing for pacemakers did not improve left ventricular function compared to apical pacing in patients with atrioventricular block. Long-term outcomes for heart failure parameters were similar between the two lead placement groups.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Right ventricular apical pacing can potentially alter left ventricular function.
- Dual-chamber pacemaker implantation is a common procedure for managing atrioventricular block.
Purpose of the Study:
- To compare long-term left ventricular dysfunction parameters between septal and apical ventricular lead placement in pacemaker recipients.
- To evaluate the impact of lead positioning on heart failure indicators.
Main Methods:
- A randomized trial of 98 patients with atrioventricular block undergoing pacemaker implantation.
- Ventricular lead placement was randomized to the septum (n=53) or apex (n=45).
- N-terminal pro-brain natriuretic peptide (BNP) levels, left ventricular ejection fraction (LVEF), and exercise capacity were assessed at baseline, 3 days, 3 months, and 18 months.
Main Results:
- No statistically significant differences in changes of BNP levels, LVEF, or exercise capacity were observed between septal and apical pacing groups at 18 months.
- The incidence or worsening of overt heart failure was comparable in both septal and apical pacing groups.
Conclusions:
- Septal pacing is not superior to conventional apical pacing for managing parameters of congestive heart failure in unselected patients with atrioventricular block.
- Lead positioning in the septum does not offer an advantage over apical pacing regarding long-term cardiac function and heart failure outcomes.
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.
