期刊
EUROPEAN HEART JOURNAL
卷 36, 期 14, 页码 856-862出版社
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehu304
关键词
Right ventricular apical pacing; Right ventricular high septal pacing; Left ventricular function; Select site pacing
资金
- Medtronic Ltd.
- St Jude Medical
- Boston Scientific
- Boehringer Ingelheim GmBH
- Pfizer UK
- Medtronic Ltd., UK
Aim Chronic right ventricle (RV) apical (RVA) pacing is standard treatment for an atrioventricular (AV) block but may be deleterious to left ventricle (LV) systolic function. Previous clinical studies of non-apical pacing have produced conflicting results. The aim of this randomized, prospective, international, multicentre trial was to compare change in LV ejection fraction (LVEF) between right ventricular apical and high septal (RVHS) pacing over a 2-year study period. Methods and results We randomized 240 patients (age 74 +/- 11 years, 67% male) with a high-grade AV block requiring > 90% ventricular pacing and preserved baseline LVEF > 50%, to receive pacing at the RVA (n = 120) or RVHS (n = 120). At 2 years, LVEF decreased in both the RVA (57 +/- 9 to 55 +/- 9%, P = 0.047) and the RVHS groups (56 +/- 10 to 54 +/- 10%, P = 0.0003). However, there was no significant difference in intra-patient change in LVEF between confirmed RVA (n = 85) and RVHS (n = 83) lead position (P = 0.43). There were no significant differences in heart failure hospitalization, mortality, the burden of atrial fibrillation, or plasma brain natriutetic peptide levels between the two groups. A significantly greater time was required to place the lead in the RVHS position (70 +/- 25 vs. 56 +/- 24 min, P < 0.0001) with longer fluoroscopy times (11 +/- 7 vs. 5 +/- 4 min, P < 0.0001). Conclusion In patients with a high-grade AV block and preserved LV function requiring a high percentage of ventricular pacing, RVHS pacing does not provide a protective effect on left ventricular function over RVA pacing in the first 2 years.
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