right ventricular lead placement in a pacemaker

RIGHT VENTRICULAR LEAD PLACEMENT IN A PACEMAKER
POPULATION: COMPARISON OF APICAL AND SEPTAL POSITIONS
Giovanni Luca Botto - Ospedale Sant'Anna, San Fermo della Battaglia (CO); Valeria Calvi - A.O.U.
"Policlinico Vittorio Emanuele", P.O. Ferrarotto, Catania; Domenico Pecora - Ospedale
Poliambulanza, Brescia; Gianfranco Ciaramitaro - Policlinico Giaccone, Palermo; Giampiero Maglia
- A. O. Pugliese-Ciaccio, Catanzaro; Michelangelo Canciello - Ospedale S. Maria di Loreto Mare,
Napoli; Daniele Porcelli - Ospedale San Pietro Fatebenefratelli, Roma; Marco Racheli - Ospedale
Civile La Memoria, A. O. Desenzano del Garda, Gavardo (BS); Alessandro Costa - Ospedale "Sacro
Cuore - Don Calabria", Negrar (VR); Gabriele Giannola - Fondazione Istituto San Raffaele - G. Giglio,
Cefalù (PA); Alessio Lilli - Nuovo Ospedale della Versilia, Lido di Camaiore (LU); Maurizio Malacrida
- Boston Scientific Italia, Milano; Carmine Muto - Ospedale S. Maria della Pietà, Nola
Purpose: Purpose of this study was to acute evaluate variation in the temporal pattern of mechanical
activation of the LV during pacing at a septal RV site (RVS) and at a standard apical site (RVA).
Methods: 438 patients with a DDD/DR pacemaker were enrolled in 14 centers. The delay between
septum and lateral wall contraction (SLD), as recorded by means of TDI echocardiography, was
assessed during spontaneous LV activation (SLVA) and during RV pacing (RVP).
Results: RVA patients were 268 (61%) and RVS patients were 170 (39%). The two groups were similar
in terms of EF, prevalence of CAD and QRS duration. During SLVA, SLD was comparable between
groups (47±26ms versus 52±28ms). During RVP, SLD increased to 57±28ms in RVA and 61±30ms in
RVS (p=0.333). Nonetheless, the QRS increased by 45±29ms versus 36±27ms in RVA and RVS,
respectively (p=0.017).
Conclusions: Although pacing at the RVS resulted in less marked QRS lengthening than pacing at the
RVA, it did not reduce the pacing-induced LV-dyssynchrony. However, the comparison of long-term
results will elucidate whether septal pacing is associated with better patient outcome.

Download Report