Effects of Septal Atrial Pacing and Right Ventricular Septal Pacing in Dual Chamber Pacemaker Implantation

Abstract Background： Patients implanted with pacemakers frequently develop atrial fibrillation. Pacemaker-detected atrial high-rate episodes or AHREs, where one AHRE is defined as ≥ 160beats/min lasting ≥ 5 minutes, may identify patients at increased risk for stroke and death. In this study, we sought to observe whether patients with sinus node dysfunction or atria-ventricular block are more likely to develop AHREs. Methods: A total of 103 patients (age 69.4±13.5 years，58% female) with DDD/DDDR pacemakers were enrolled for the study. These pacemakers were equipped with features that enabled the detection and storage of information such as the dates, durations and sequential episodes of AHRE. Patients were followed up for 2 years and the time of the first occurrence of AHRE was determined at follow-up visit. Other data such as age, gender, structural heart disease, concomitant non-cardiac diseases, the cumulative percentage of atrial pacing (Cum% AP) and ventricular pacing (Cum% VP) were also collected. Results: Atrial fibrillation developed frequently after the dual-chamber pacemaker implantation. AHRE occurred more often in patients with sinus node disease (SND) than those with atrioventricular block (AVB) （OR, 2.553; 95%CI, 1.122-5.814；P=0.045）. Conclusions: AHRE developed frequently after dual-chamber pacemaker implantation. Patients with SND are more likely to develop AF compared to the patients with AVB.

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Intermittent capture of the right ventricular outflow tract by atrial pacing in a patient with a dual-chamber pacemaker

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2012.06.018 ◽

2012 ◽

Vol 45 (6) ◽

pp. 787-789 ◽

Cited By ~ 3

Author(s):

Julio Daniel Pastori ◽

Hugo Ariel Garro ◽

Adrián Baranchuk ◽

Pablo Ambrosio Chiale

Keyword(s):

Right Ventricular ◽

Right Ventricular Outflow Tract ◽

Ventricular Outflow Tract ◽

Outflow Tract ◽

Atrial Pacing ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

The Right

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Is the right ventricular function affected by permanent pacemaker?

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.003 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

N Bachani ◽

A Bagchi ◽

K Sinkar ◽

JP Jadwani ◽

GK Panicker ◽

...

Keyword(s):

Ejection Fraction ◽

Right Ventricular ◽

Pacemaker Implantation ◽

Three Dimensional ◽

Av Block ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Rv Pacing ◽

Rv Function

Abstract Funding Acknowledgements Type of funding sources: None. Background The effect of right ventricular (RV) pacing on left ventricular (LV) function has been extensively evaluated, and so has the effect of the RV pacing lead on tricuspid valve function. However, the effects on RV function per se have not been evaluated systematically. Purpose We aimed to assess the RV dimensions and RV function six months after dual chamber pacemaker implantation performed for atrioventricular (AV) block by detailed echocardiography, including three-dimensional (3D) echocardiography. Method All adult patients undergoing dual chamber pacemaker from January 2018 to March 2019 for symptomatic AV block with a structurally normal heart were included in the study. They underwent pre-procedure detailed echocardiography specifically directed at measuring RV dimensions and function [including 3D RV ejection fraction (EF)] and a repeat detailed echocardiogram at six-month follow-up, by the same echocardiographer. The echocardiographic parameters at baseline and after six-month follow-up were compared. Results All patients had more than 75% ventricular pacing in these six months. At six-month follow-up, there was no significant change in LVEF, while there was a mild decrease in RVEF as outlined in the Table 1. While there was some overlap between RVEF range of values at baseline and after six months, 23 (38.3%) patients showed a drop in RVEF by >5%. Conclusion Our study shows a change in several RV function parameters in a majority of patients six months after pacemaker implantation for AV block. RV Function at six month follow-up Parameters Pre-procedure Six-Month Follow-up p value (Paired t-test) PASP (mm Hg) 20.2 ± 1.3 26.1 ± 12.2 <0.001 FAC (%) 42.6 ± 3.4 39.4 ± 6 <0.001 TAPSE (mm) 18.4 ±3.8 15.6 ± 4.7 <0.001 RIMP 0.66 ± 0.09 0.61 ± 0.11 0.003 RV E/E’ 9.4 ± 2.1 7.7 ± 2.1 <0.001 RV S’ 13.6 ± 2.4 10.7 ± 2.4 <0.001 RVEF % [By 3D Echocardiography] 47.7± 5.1 44.9 ± 7.4 <0.001 TR Jet Area (cm2) 0.03 ± 0.26 0.55 ± 0.96 <0.001 RV= Right Ventricle; RA= Right Atrium; RVOT = Right Ventricular Outflow Tract; PASP = Pulmonary Artery Systolic Pressure; FAC= Fractional Area Change; TAPSE= Tricuspid Annular Plane Systolic Excursion; RIMP = Right Ventricular Index of Myocardial Performance; TR = Tricuspid Regurgitation S’ = Peak Systolic Annular Velocity; RVEF = Right Ventricular Ejection Fraction; 3D = Three Dimensional Abstract Figure. Change in RVEF in 6 months

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Abstract 12776: Long Term Mortality With Right Ventricular Apical Versus Septal Pacing

Circulation ◽

10.1161/circ.132.suppl_3.12776 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Chance M Witt ◽

Charles J Lenz ◽

Henry H Shih ◽

Elisa Ebrille ◽

Andrew N Rosenbaum ◽

...

Keyword(s):

Right Ventricular ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Dual Chamber Pacemaker ◽

Lead Position ◽

Ventricular Lead ◽

Significant Difference ◽

Long Term Mortality

Introduction: Right ventricular apical (RVA) pacing appears to have detrimental effects on cardiac function and long term outcomes. Right ventricular non-apical (RVNA) pacing, especially in the septal position, has been postulated as an alternative that may lead to less morbidity and mortality. Prior studies have shown conflicting results and been limited by small numbers and short follow-up. We aimed to determine if right ventricular septal lead position was associated with a reduction in long-term mortality compared to RVA lead position. Methods: Patients who underwent dual-chamber pacemaker implantation from 2004 through 2013 were evaluated for right ventricular lead position based on chest radiographs. Lead positions were divided in to apical or non-apical. Non-apical lead positions were subdivided to isolate a septal lead position group. Mortality was compared between these groups. Results: During the study period, 3456 patients underwent dual-chamber pacemaker placement and had images appropriate for lead position evaluation. The group was 53.5% male with a mean age of 74 ± 13 years. RVNA lead position was found in 976 (28.2%) patients, including 243 (7.0%) with a septal position. There was no significant difference in age or prior heart failure diagnosis between groups. Kaplan-Meier survival analysis did not reveal a significant difference in mortality between patients with RVA versus RVNA lead position during 5 year follow-up (p = 0.82). However, septal lead position was associated with a significantly lower mortality compared with RVA position (p = 0.03) (figure). Conclusions: Right ventricular septal lead position is associated with a lower long-term mortality than RVA lead position. This has substantial implications regarding the preferred site for ventricular pacing lead placement.

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Dual chamber pacemaker implantation during atrial fibrillation in patients with PAF

EP Europace ◽

10.1016/s1099-5129(01)80288-9 ◽

2001 ◽

Vol 2 ◽

pp. A71-A71

Keyword(s):

Atrial Fibrillation ◽

Pacemaker Implantation ◽

Dual Chamber ◽

Dual Chamber Pacemaker

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Usefulness of lead delivery catheter system for true right ventricular septal pacing

European Heart Journal ◽

10.1093/ehjci/ehaa946.0770 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Miyajima ◽

T Urushida ◽

K Ito ◽

F Kin ◽

A Okazaki ◽

...

Keyword(s):

Right Ventricular ◽

Pacemaker Implantation ◽

Septal Wall ◽

Catheter Group ◽

Catheter System ◽

Septal Pacing ◽

Ventricular Activation ◽

Pacing Lead ◽

Guiding Catheter ◽

Delivery Catheter

Abstract Background Right ventricular (RV) septal pacing is often selected to preserve a more physiologic ventricular activation. But the pacing leads are not always located in true septal wall, rather in hinge or free wall in some cases with the conventional stylet-guided lead implantation. In recent years, new guiding catheter systems has attracted attention as a solution to that problem. Objective The aim of this study is to investigate that true ventricular sepal pacing can be achieved by use of the new guiding catheter system for pacing lead. Methods We enrolled 198 patients who underwent RV septal lead implantation and computed tomography (CT) after pacemaker implantation. 16 cases were used delivery catheter (Delivery), and 182 cases were used stylet for targeting ventricular septum (Conventional). We analyzed the lead locations with CT, and evaluated capture thresholds, R-wave amplitudes, lead impedances and 12-lead electrocardiogram findings one month after implantation. Results All cases of delivery catheter group had true septal lead positions (Delivery; 100% vs Conventional; 44%, p<0.01). Capture thresholds and lead impedances had not significant differences between between two groups (0.65±0.15V vs 0.60±0.15V, p=0.21, 570±95Ω vs 595±107Ω, p=0.39, respectively). R-wave amplitudes were significantly higher in delivery catheter group (13.0±4.8mV vs 10±4.6mV, p<0.01). Paced QRS durations were shorter in delivery catheter group (128±16ms vs 150±21ms, p<0.01). Conclusions The delivery catheter system designated for pacing lead can contribute to select the true ventricular septal sites and to attain the more physiologic ventricular activation. Funding Acknowledgement Type of funding source: None

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