Retrospective Cohort Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Aug 26, 2015; 7(8): 490-498
Published online Aug 26, 2015. doi: 10.4330/wjc.v7.i8.490
Right ventricular septal pacing: Safety and efficacy in a long term follow up
Eraldo Occhetta, Gianluca Quirino, Lara Baduena, Rosaria Nappo, Chiara Cavallino, Emanuela Facchini, Paolo Pistelli, Andrea Magnani, Miriam Bortnik, Gabriella Francalacci, Gabriele Dell’Era, Laura Plebani, Paolo Marino
Eraldo Occhetta, Rosaria Nappo, Emanuela Facchini, Andrea Magnani, Miriam Bortnik, Gabriella Francalacci, Gabriele Dell’Era, Laura Plebani, Paolo Marino, Cardiology Department, AOU Maggiore della Carità, 28100 Novara, Italy
Gianluca Quirino, Cardiology Division, P.O. SS. Annunziata, 87100 Cosenza, Italy
Lara Baduena, Cardiology Division, Ospedale SS. Trinità, 28021 Borgomanero, Italy
Chiara Cavallino, Cardiology Division, Ospedale S. Andrea, 13100 Vercelli, Italy
Paolo Pistelli, Cardiology Division, Ospedale Civile, 10015 Ivrea, Italy
Author contributions: All the authors contributed to this paper.
Institutional review board statement: The study was reviewed and approved for publication by our Institutional Reviewer.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at eraldo.occhetta@maggioreosp.novara.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Eraldo Occhetta, Cardiology Department, AOU Maggiore della Carità, Corso Mazzini 18, 28100 Novara, Italy. eraldo.occhetta@maggioreosp.novara.it
Telephone: +39-321-3733413 Fax: +39-321-3733142
Received: January 25, 2015
Peer-review started: January 25, 2015
First decision: March 6, 2015
Revised: June 5, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: August 26, 2015
Processing time: 214 Days and 6.1 Hours
Abstract

AIM: To evaluate the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing.

METHODS: We retrospectively evaluated: (1) 244 patients (74 ± 8 years; 169 men, 75 women) implanted with a single (132 pts) or dual chamber (112 pts) pacemaker (PM) with ventricular screw-in lead placed at the right ventricular high septal parahisian site (SEPTAL pacing); (2) 22 patients with permanent pacemaker and low percentage of pacing (< 20%) (NO pacing); (3) 33 patients with high percentage (> 80%) right ventricular apical pacing (RVA). All patients had a narrow spontaneous QRS (101 ± 14 ms). We evaluated New York Heart Association (NYHA) class, quality of life (QoL), 6 min walking test (6MWT) and left ventricular function (end-diastolic volume, LV-EDV; end-systolic volume, LV-ESV; ejection fraction, LV-EF) with 2D-echocardiography.

RESULTS: Pacing parameters were stable during follow up (21 mo/patient). In SEPTAL pacing group we observed an improvement in NYHA class, QoL score and 6MWT. While LV-EDV didn’t significantly increase (104 ± 40 mL vs 100 ± 37 mL; P = 0.35), LV-ESV slightly increased (55 ± 31 mL vs 49 ± 27 mL; P = 0.05) and LV-EF slightly decreased (49% ± 11% vs 53% ± 11%; P = 0.001) but never falling < 45%. In the RVA pacing control group we observed a worsening of NYHA class and an important reduction of LV-EF (from 56% ± 6% to 43% ± 9%, P < 0.0001).

CONCLUSION: Right ventricular permanent high septal pacing is safe and effective in a long term follow up evaluation; it could be a good alternative to the conventional RVA pacing in order to avoid its deleterious effects.

Keywords: Right ventricular septal pacing, Parahisian pacing, Resynchronization therapy, Left ventricular cardiac function, Permanent cardiac pacing

Core tip: We evaluated the safety and efficacy of the permanent high interventricular septal pacing in a long term follow up, as alternative to right ventricular apical pacing. We retrospective evaluated 244 patients with a narrow QRS implanted with a single/dual chamber pacemaker with ventricular screw-in lead placed at the right ventricular high septal (parahisian) site. Contemporary we checked the clinical evolution of two control groups of patients: without ventricular stimulation and with conventional right ventricular apical stimulation. In a long term follow up we observed stability of pacing parameters and ejection fraction, and improvement in New York Heart Association class, quality of life and exercise tolerance.