Effect on Cardiac Function of the Right Ventricular Mid-Septal Pacing Procedure with Narrow QRS Complexes in Patients with Permanent Pacemaker Implantation

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Introduction: In pacemaker implantation, ventricular pacing leads were conventionally positioned on the right ventricular apex (RVA). However, this procedure causes some deleterious effects. It has been reported that an alternative procedure i.e., the right ventricular mid-septal (RVMS) pacing makes a narrow QRS complexes. In this study, we compared cardiac function between the RVA pacing and the RVMS pacing with one-year follow-up. Methods: We enrolled 136 RVMS-pacing patients (76±11 years) who underwent a permanent pacemaker implantation suffering from bradyarrhythmias. Pacemaker indices, a paced QRS duration, and brain natriuetic peptide (BNP) were measured one-year after implantation. These data were compared to 60 RVA-pacing patients. Results: Pacemaker indices did not differ between the RVMS-pacing and the RVA-pacing. A paced QRS duration in the RVMS-pacing was shorter than that of the RVA-pacing (124±17 vs. 148±11 ms, P<0.01). BNP levels one-year after implantation were not increased in the RVMS-pacing, whereas it was increased in the RVA-pacing (9% vs. 22%, P<0.01). Conclusion: This prospective observational study reveals that an alternative RVMS-pacing procedure contributes to less conduction delay and cardiac dysfunction compared with a conventional RVA pacing procedure in patients with permanent pacemaker implantation.