JZUS - Journal of Zhejiang University SCIENCE

Journal of Zhejiang University SCIENCE B 2014 Vol.15 No.6 P.507-514

Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?*

Author(s): Kang Chen¹, Ye Mao², Shao-hua Liu¹, Qiong Wu¹, Qing-zhi Luo¹, Wen-qi Pan¹, Qi Jin¹, Ning Zhang¹, Tian-you Ling¹, Ying Chen¹, Gang Gu¹, Wei-feng Shen¹, Li-qun Wu¹
Affiliation(s): 1. Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; more
Corresponding email(s): rjshenweifeng@gmail.com
Key Words: Mid-septal pacing, Apical pacing, Impaired heart function

Share this article to： More \|Next Article >>>

Abstract: Objective: We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. Methods: Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. Results: Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%–40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions: RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.

轻度心功能受损的高度房室传导阻滞患者采用中位间隔部起搏是否优于心尖部起搏？

研究目的：对于轻度心功能受损的高度房室传导阻滞患者，明确右室起搏的最优化位置，同时明确哪一类患者能够从最优化的右心室起搏中获益。
创新要点：首次明确相比于右心室心尖部起搏，中位间隔部起搏明显改善轻度心功能受损，尤其是左室射血分数在35%~40%的高度房室传导阻滞患者的临床预后。
研究方法：随机分配进入中位间隔部起搏或心尖部起搏的患者，在基线状态下记录N-末端脑钠肽前体、六分钟步行试验以及心超结果；随访18个月后观察上述结果变化。同时，根据射血分数的不同进行亚组分析。
重要结论：相比于右心室心尖部起搏，中位间隔部起搏能够改善轻度心功能受损的高度房室传导阻滞患者的临床预后，尤其对于左室射血分数在35%~40%的患者。

关键词：右心室中位间隔部起搏；右心室心尖部起搏；心功能受损

References

[1] Cano, O., Osca, J., Sancho-Tello, M.J., 2010. Comparison of effectiveness of right ventricular septal pacing versus right ventricular apical pacing. Am J Cardiol, 105(10):1426-1432.

[2] Chiladakis, J.A., Koutsogiannis, N., Kalogeropoulos, A., 2007. Permanent and atrial-synchronized ventricular stimulation for clinically stable patients with normal or impaired left ventricular systolic function. Pacing Clin Electrophysiol, 30(2):182-187.

[3] Cleland, J.G., Daubert, J.C., Erdmann, E., 2005. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med, 352(15):1539-1549.

[4] Doshi, R.N., Daoud, E.G., Fellows, C., 2005. Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the pave study). J Cardiovasc Electrophysiol, 16(11):1160-1165.

[5] Epstein, A.E., Dimarco, J.P., Ellenbogen, K.A., 2008. ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities. Heart Rhythm, 5(6):e1-e62.

[6] Flevari, P., Leftheriotis, D., Fountoulaki, K., 2009. Long-term nonoutflow septal versus apical right ventricular pacing: relation to left ventricular dyssynchrony. Pacing Clin Electrophysiol, 32(3):354-362.

[7] Goldenberg, I., Moss, A.J., Hall, W.J., 2011. Predictors of response to cardiac resynchronization therapy in the multicenter automatic defibrillator implantation trial with cardiac resynchronization therapy (MADIT-CRT). Circulation, 124(14):1527-1536.

[8] Gong, X., Su, Y., Pan, W., 2009. Is right ventricular outflow tract pacing superior to right ventricular apex pacing in patients with normal cardiac function?. Clin Cardiol, 32(12):695-699.

[9] Kaye, G., Stambler, B.S., Yee, R., 2009. Search for the optimal right ventricular pacing site: design and implementation of three randomized multicenter clinical trials. Pacing Clin Electrophysiol, 32(4):426-433.

[10] Kindermann, M., Hennen, B., Jung, J., 2006. Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol, 47(10):1927-1937.

[11] Kypta, A., Steinwender, C., Kammler, J., 2008. Long-term outcomes in patients with atrioventricular block undergoing septal ventricular lead implantation compared with standard apical pacing. Europace, 10(5):574-579.

[12] Lee, M.A., Dae, M.W., Langberg, J.J., 1994. Effects of long-term right ventricular apical pacing on left ventricular perfusion, innervation, function and histology. J Am Coll Cardiol, 24(1):225-232.

[13] Leong, D.P., Mitchell, A.M., Salna, I., 2010. Long-term mechanical consequences of permanent right ventricular pacing: effect of pacing site. J Cardiovasc Electrophysiol, 21(10):1120-1126.

[14] Lieberman, R., Grenz, D., Mond, H.G., 2004. Selective site pacing: defining and reaching the selected site. Pacing Clin Electrophysiol, 27((6 Pt 2)):883-886.

[15] McGavigan, A.D., Roberts-Thomson, K.C., Hillock, R.J., 2006. Right ventricular outflow tract pacing: radiographic and electrocardiographic correlates of lead position. Pacing Clin Electrophysiol, 29(10):1063-1068.

[16] Mera, F., Delurgio, D.B., Patterson, R.E., 1999. A comparison of ventricular function during high right ventricular septal and apical pacing after His-bundle ablation for refractory atrial fibrillation. Pacing Clin Electrophysiol, 22(8):1234-1239.

[17] Muto, C., Ottaviano, L., Canciello, M., 2007. Effect of pacing the right ventricular mid-septum tract in patients with permanent atrial fibrillation and low ejection fraction. J Cardiovasc Electrophysiol, 18(10):1032-1036.

[18] Shimony, A., Eisenberg, M.J., Filion, K.B., 2012. Beneficial effects of right ventricular non-apical vs. apical pacing: a systematic review and meta-analysis of randomized-controlled trials. Europace, 14(1):81-91.

[19] Stambler, B.S., Ellenbogen, K., Zhang, X., 2003. Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol, 14(11):1180-1186.

[20] Sweeney, M.O., Hellkamp, A.S., 2006. Heart failure during cardiac pacing. Circulation, 113(17):2082-2088.

[21] Tantengco, M.V., Thomas, R.L., Karpawich, P.P., 2001. Left ventricular dysfunction after long-term right ventricular apical pacing in the young. J Am Coll Cardiol, 37(8):2093-2100.

[22] Victor, F., Leclercq, C., Mabo, P., 1999. Optimal right ventricular pacing site in chronically implanted patients: a prospective randomized crossover comparison of apical and outflow tract pacing. J Am Coll Cardiol, 33(2):311-316.

[23] Victor, F., Mabo, P., Mansour, H., 2006. A randomized comparison of permanent septal versus apical right ventricular pacing: short-term results. J Cardiovasc Electrophysiol, 17(3):238-242.

[24] Vlay, S.C., 2006. Right ventricular outflow tract pacing: practical and beneficial. A 9-year experience of 460 consecutive implants. Pacing Clin Electrophysiol, 29(10):1055-1062.

[25] Zhang, H.X., Qian, J., Hou, F.Q., 2012. Comparison of right ventricular apex and right ventricular outflow tract septum pacing in the elderly with normal left ventricular ejection fraction: long-term follow-up. Kardiol Pol, 70(11):1130-1139.

Similar articles

- Go to

轻度心功能受损的高度房室传导阻滞患者采用中位间隔部起搏是否优于心尖部起搏？

Darkslateblue:Affiliate; Royal Blue:Author; Turquoise:Article

References