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Published on: December 11, 2017
Practical Septal Pacing for Atrioventricular Block: A Simplified Septal Strategy With Stable Thresholds Compared With
Shun Takeuchi1, Rie Aoyama1, Takashi Uchiyama1
1Department of Cardiology, Funabashi Municipal Medical Center Chiba Japan.
Circulation Reports
|June 11, 2026
Summary
Practical septal pacing (PSP) offers a simpler alternative for atrioventricular block (AVB) patients, demonstrating lower and more stable pacing thresholds compared to His bundle pacing (HBP). This method ensures comparable safety and efficacy over 18 months.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- His bundle pacing (HBP) is a physiological pacing method for atrioventricular block (AVB).
- HBP may be associated with unstable pacing thresholds.
- Practical septal pacing (PSP) is proposed as an alternative for AVB.
Purpose of the Study:
- To evaluate the feasibility and performance of practical septal pacing (PSP) in patients with atrioventricular block (AVB).
- To compare pacing thresholds and long-term outcomes of PSP versus His bundle pacing (HBP).
Main Methods:
- A study involving 92 patients with AVB (41 HBP, 51 PSP).
- PSP was optimized for the narrowest achievable paced QRS duration (pQRSd) with acceptable parameters.
- Pacing thresholds and clinical outcomes were assessed at implantation and 18 months.
Main Results:
- Implantation pQRSd was similar between HBP and PSP groups.
- PSP demonstrated significantly lower initial pacing thresholds (0.5V vs. 1.0V) compared to HBP, which persisted at 18 months.
- High pacing thresholds (≥2.5V) were less frequent with PSP (2% vs. 27%), with no septal perforations and comparable 1-year survival and heart failure hospitalization rates.
Conclusions:
- Practical septal pacing (PSP) provides a viable and potentially simpler pacing strategy for AVB.
- PSP is associated with more stable and lower pacing thresholds compared to HBP.
- PSP shows comparable safety and efficacy to HBP in the short term.
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