Right Ventricular Septal Pacing vs. Right Ventricular Apical Pacing Following Atrioventricular Node Ablation: A 10-Year Follow-up

Background: Right Ventricular Septal (RVS) pacing is often recommended as a more physiological alternative to Right Ventricular Apical (RVA) pacing. Objectives: This study aimed to determine the long-term outcomes in patients persistently paced following Atrioventricular Node (AVN) ablation. Materials and Methods: This study was conducted on 200 patients who underwent Permanent Pacemaker (PPM) implantation prior to AVN ablation with either RVA- or RVS-pacing. Primary endpoints were hospitalization due to Heart Failure (HF) and death. Secondary endpoints included changes in Ejection Fraction (EF), inter- and intra-ventricular dyssynchrony measures, and paced QRS duration. Demographic data were obtained from all patients. In addition, CT chest examinations were analyzed to confirm RVS lead position. Results: The mean survival time from AVN ablation was 6.32 +/- 4.294 years in the RVA group and 3.00 +/- 2.546 years in the RVS group (hazard ratio = 3.512, P = 0.0001). The results showed no significant differences between the two sites regarding hospitalization due to HF. Baseline and follow-up EFs were respectively 48.4 +/- 13.8% and 53.1 +/- 8.5% for RVA pacing and 52.0 +/- 10.6% and 55.2 +/- 11.3% for RVS pacing (P = 0.911). Moreover, 76% of the patients in the RVS group had a septal lead confirmed on CT chest review. Twenty-four percent of the RVS leads were in alternate sites, including the RVA and free wall. Conclusions: The results revealed was no diminution in EF with either lead position at long-term follow-up. The mortality rate was significantly less in RVA pacing compared to documented septal pacing although a quarter of the RVS leads were found in alternate sites on CT chest review.