Right ventricular septal pacing in patients with right bundle branch block

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cardiac resynchronization therapy (CRT) improves left ventricular (LV) function in left bundle branch block but not right bundle branch block (RBBB).
• Standard CRT is less effective in RBBB patients.
• A novel pacing strategy is needed for RBBB patients.

Purpose of the Study:

• To investigate the efficacy of single-site right ventricular septal (RVS) pacing near the proximal right bundle in RBBB patients.
• To determine if RVS pacing can restore more normal LV activation in RBBB.

Main Methods:

• 78 consecutive patients with RBBB underwent pacemaker or ICD implantation.
• Leads were placed in the right atrium and RVS.
• QRS duration was measured at baseline and with RVS pacing at optimal AV delay.

Main Results:

• Baseline QRS duration averaged 147 ms.
• Fused QRS duration with RVS pacing averaged 112 ms.
• A significant mean decrease in QRS duration of 34 ms was observed (p<0.001).

Conclusions:

• Right ventricular septal (RVS) pacing in RBBB patients significantly reduced QRS duration.
• RVS pacing often normalized the ECG in these patients.
• This pacing method shows promise for improving outcomes in RBBB.