High Right Ventricular Septal Pacing in Elderly Patients: Mid-Term Follow-Up of Ventricular Lead Performance

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Background: Prolonged pacing from the right ventricular apex has been shown to be associated with progressive left ventricular dysfunction and so high right ventricular septal pacing has been proposed as an alternative to apical pacing; however, there is currently no information on mid-term ventricular lead electrical performance from this site in elderly patients. Methods: Consecutive elderly patients who had undergone pacemaker implantation with high right ventricular septal pacing were analyzed (n=23, mean age 78±4 years, 12 men). Mid-term follow up (109±9 days) was performed for all patients. Information on the stimulation threshold, R-wave sensing, lead impedance and lead complications was collected. Results: Lead performance at the high right ventricular septal position was stable in the mid-term. Ventricular electrical parameters were acceptable with stable mid-term stimulation thresholds, sensing and impedance. At about three-month follow-up, a mean stimulated threshold of 0.98±0.41 V, mean R wave of 7.25±3.42 mV and mean impedance value of 629±193 omega were demonstrated. There was no case of a high pacing threshold, inadequate sensing or lead dislodgement. Conclusion: This study confirms the satisfactory mid-term performance of leads placed on the high right ventricular septum in elderly patients.