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Translational Rabbit Model of Chronic Cardiac Pacing

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Association Between Septal Implantation Level and Pacing Threshold Stability in Leadless Pacemaker Implantation.

Dong-Hyeok Kim¹, Yeji Kim¹, Seung Woo Lee²

¹Division of Cardiology, Ewha Womans University Seoul Hospital, Seoul 07804, Republic of Korea.

Journal of Clinical Medicine

|January 28, 2026

Summary

Implanting leadless pacemakers (LPs) in the mid or upper right ventricular septum (RVS) leads to more stable pacing thresholds compared to lower RVS sites. This finding suggests optimal anatomical targeting is crucial for leadless pacemaker efficacy.

Keywords:

leadless pacemaker threshold

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Area of Science:

Cardiology
Medical Devices
Electrophysiology

Background:

Leadless pacemakers (LPs) are a safe alternative to transvenous pacing systems.
Optimal implantation sites within the right ventricular septum (RVS) for LPs are debated.
The impact of implantation site on long-term pacing threshold stability requires further investigation.

Purpose of the Study:

To evaluate the relationship between the specific pacing site within the RVS and pacing threshold stability after LP implantation.
To compare pacing outcomes based on device position in the RVS.

Main Methods:

Retrospective analysis of 36 patients who underwent LP implantation.
Patients grouped by final device position: mid/upper RVS (Group A, n=8) vs. low/apical RVS (Group B, n=28).
Assessment of pacing threshold, QRS duration, and left ventricular ejection fraction (LVEF) over 6 months.

Main Results:

Group A (mid/upper RVS) showed significantly lower and more stable pacing thresholds at 6 months (0.57 ± 0.09 mV) compared to Group B (low/apical RVS) (1.55 ± 0.97 mV, p < 0.001).
No significant differences in QRS duration or LVEF changes between groups.
No new-onset tricuspid regurgitation observed via echocardiography.

Conclusions:

Mid or upper RVS implantation sites may be associated with superior pacing threshold stability.
Findings are hypothesis-generating due to small sample size, particularly in Group A.
Further prospective studies with advanced imaging are needed to confirm these results and assess long-term clinical outcomes.