Septal versus apical pacing sites in permanent right ventricular pacing: The multicentre prospective SEPTAL-PM study

ventricular apical pacing has been associated with left ventricular ejection fraction impairment and heart failure. Right ventricular septal pacing has been proposed as an alternative. Aim. - The aim of this randomized prospective multicentre trial was to compare left ventricular remodelling and outcomes between right ventricular apical and septal pacing after mid-term follow-up. Methods. - Patients requiring pacemaker implantation for high-degree atrioventricular block were enrolled and randomized in a 1:1 fashion to receive a right ventricular apical or septal lead. Results. - A total of 141 patients were included, 69 in the septal group and 72 in the api-cal group. Both groups exhibited similar left ventricular ejection fractions after 18 months of follow-up (septal 57.1 +/- 11.9% vs. apical 57.4 +/- 13.4%), and left ventricular ejection fraction variation was similar in the two groups at the end of follow-up (septal -1.5 +/- 13.2% vs. apical 0.3 +/- 13.3%). Additionally, left ventricular volume, quality of life and 6-minute walk distance were similar in the two groups. However, patients in the septal group were more likely to be asymptomatic, with a significantly lower concentration of N-terminal prohormone of brain natriuretic peptide. Lastly, lead position did not impact 18-month survival. Conclusion. - Pacing from the right ventricular apex does not have any detrimental effect on left ventricular systolic function compared with septal pacing over an 18-month period. (c) 2022 Published by Elsevier Masson SAS.