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Alternative sites for right ventricular pacing in Chagas disease: a comparative study of the mid-septum and inflow
Otaviano da Silva Júnior1, Maria Cândida Calzada Borges, Celso Salgado de Melo
1Department of Cardiac Pacing, Federal University of Triangulo Mineiro, Uberaba, Brazil.
Insights
Right ventricular mid-septum pacing is a safer alternative for patients with Chagas disease compared to inflow tract pacing. This approach reduces cardiac dysfunction progression and electromechanical dyssynchrony, improving patient outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Chagas Disease Research
Background:
- Right ventricular pacing is crucial for managing bradyarrhythmias.
- Alternative pacing sites like the mid-septum and inflow tract are explored to minimize cardiac dysfunction.
- Chronic Chagas disease (CCC) presents unique challenges for pacemaker implantation and cardiac management.
Purpose of the Study:
- To compare the clinical impact of right ventricular mid-septum versus inflow tract pacing in patients with Chagas disease.
- To evaluate the effects of these pacing sites on the progression of chronic chagasic cardiomyopathy (CCC).
- To assess the influence on electrocardiographic parameters, left ventricular remodeling, and electromechanical dyssynchrony.
Main Methods:
- Randomized controlled trial involving 80 patients with Chagas disease requiring pacemaker implantation.
- Patients were assigned to either mid-septum (n=40) or inflow tract (n=40) pacing groups.
- Clinical and electrophysiological assessments, including CCC progression, QRS duration, left ventricular remodeling, and dyssynchrony, were performed at baseline and 18-month follow-up.
Main Results:
- Mid-septum pacing demonstrated slower CCC progression and narrower QRS complexes compared to inflow tract pacing (131.8 ms vs 150.5 ms).
- No significant left ventricular remodeling was observed in either group.
- Intraventricular and interventricular dyssynchrony were significantly more frequent in the inflow tract group (85% and 37.5%) than in the mid-septum group (32.5% and 17.5%).
Conclusions:
- Right ventricular mid-septum pacing is associated with better clinical outcomes in Chagas disease patients.
- This pacing site leads to slower cardiomyopathy progression and reduced electromechanical dyssynchrony.
- Mid-septum implantation appears to be a safer alternative, potentially preserving cardiac function more effectively than inflow tract pacing.
Background:
The right ventricular mid-septum and inflow tract are alternative pacing sites that are potentially less harmful to cardiac function.
Objective:
This study aimed to analyze the influence of these two alternative pacing sites on the clinical course of patients with chronic Chagas disease, who underwent definitive pacemaker implantation.
Methods:
A total of 80 patients with Chagas disease and classical indications for definitive pacemaker implantation were randomized into two groups between October 2008 and August 2010: 40 received inflow tract implantation and 40 patients received mid-septum implantation. The analyzed parameters included: (1) progression stage of chronic chagasic cardiomyopathy (CCC), (2) electrocardiographic analysis, (3) left ventricular remodeling, and (4) electromechanical dyssynchrony. The assessment was performed 24-48 hours after implantation and a follow-up period of 18 months.
Results:
Compared with inflow tract implantation, mid-septum implantation was associated with slower CCC progression and the generation of narrower QRS complexes (131.8 ± 8.4 milliseconds vs 150.5 ± 10.5 milliseconds; P < 0.01). No left ventricular remodeling was detected. Intraventricular dyssynchrony was more frequent in the inflow tract group than in the mid-septum group (85% vs 32.5%, respectively; odds ratio [OR], 9.15; P = 0.02) as was interventricular dyssynchrony (37.5% vs 17.5%, respectively; OR, 2.83; P < 0.01).
Conclusions:
Mid-septum implantation was associated with slower CCC progression, generation of narrower QRS complexes, and lower electromechanical dyssynchrony, suggesting that this pacing site could be less harmful to cardiac function than the inflow tract site in patients with CCC.
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