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Right ventricular septal versus apical pacing: long-term incidence of heart failure and survival
Session:
Posters - C. Arrhythmias and Device Therapy
Speaker:
Ricardo Costa
Congress:
CPC 2021
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.1 Antibradycardia Pacing
Session Type:
Posters
FP Number:
---
Authors:
Ricardo Costa; André Frias; Andreia Campinas; Maria João Sousa; Carla Roque; Pinheiro Vieira; Vítor Lagarto; Hipólito Reis; Severo Torres
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Background: Optimal right ventricular pacing site remains controversial. Previous studies comparing right ventricular septal (RVS) and apical (RVA) pacing have small sample sizes or short follow-up. </span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Purpose: We aimed to compare the long-term incidence of heart failure (HF) and all-cause death in patients submitted to RVS and RVA pacing. </span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Methods: We retrospectively studied consecutive patients submitted to pacemaker implantation at a tertiary hospital between 1st January and 31st July 2015.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Results: Of 168 patients (78 [70-84] years, 52% male), ventricular lead was placed in apical position in 136 (81%) and in septal position in 32 (19%). Individuals with RVS pacing were younger (72 [63-81] versus 79 [72-86] years, p=0.001) and had higher prevalence of male gender (78% versus 46%, p=0.001) and atrial fibrillation (56% versus 36%, p=0.03). Median radiation time during procedure was 3 (2-6) minutes, similar between groups (p=0.60). Incidence of complications related to the procedure was low: one deep venous thrombosis of the superior limb in the RVA pacing group, one pocket infection and two diaphragm stimulation requiring lead repositioning (one atrial lead and one ventricular lead) in the RVS pacing group and one significant pocket haematoma in each group. During a median follow-up of 61 (32-65) months, all-cause death was 36%, lower in RVS pacing group (19% versus 40%, Log rank test p=0.02). Global incidence of HF was 40% (septal: 32%, apical: 42%, p=0.23). Mean QRS duration with ventricular pacing was lower in RVS pacing group (160 [15] versus 173 [20] milliseconds, p=0.03). LV systolic function during follow-up was preserved in 67% of patients, similar between groups. More patients from the RVS pacing group were submitted to upgrade to cardiac resynchronization therapy (10% versus 2%, p=0.02). In multivariate analysis, only age was an independent predictor of all-cause death (HR 1.08, 95% CI 1.04-1.14). Independent predictors of HF were significant aortic valve stenosis (HR 2.40, 95% CI 1.01-5.73), pericardial effusion (HR 9.87, 95% CI 1.25-77.73), LV hypertrophy (HR 2.45, 95% CI 1.10-5.44) and LV systolic function (if not preserved, HR 2.58, 95% CI 1.04-6.41) during follow-up.</span></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">Conclusions: In our cohort, although patients submitted to RVS pacing had lower mortality, it was not identified as an independent predictor of all-cause death or HF during a 5-year follow-up time. Procedural complications were infrequent and non-life-threatening.</span></span></span></p>
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