|previous article in this issue||next article in this issue|
Document Details :
Title: Pacing lead is more easily located at RVOT septum in patients with severe tricuspid regurgitation
Author(s): J. Wang , H. Chen , Y. Su , J. Ge
Journal: Acta Cardiologica
Volume: 71 Issue: 6 Date: 2016
Objective: The optimal right ventricular (RV) pacing site in patients referred for permanent cardiac pacing remains controversial. The present study aims to evaluate at which pacing site the electrode is more easily and steadily located in patients with severe tricuspid regurgitation (TR).
Methods and results: We prospectively enrolled 50 patients with severe TR for permanent pacemaker implantation and randomly divided them into two groups to receive either RV apex (group A) or RV outflow tract (RVOT) pacing (group B). Time of X-ray exposure for ventricular lead deployment, incidence of intra-procedural dislodgement and post-procedural cTnT level were compared between the two groups. Lead performance and echocardiographic parameters were evaluated during follow-up. Fractional shortening (FS) of both RV body and RVOT were assessed so as to analyse the wall motion of the two RV components. As a result, RV body demonstrated a significantly higher FS than RVOT (36.7 ± 5.0% vs 30.0 ± 4.6%, P < 0.01) among all TR cases. Compared with group A, less X-ray time was needed for ventricular lead implantation in group B (114.2 ± 28.9 s vs 147.2 ± 55.6 s, P = 0.011) with a lower incidence of intra-procedural dislodgement (4% vs 24%, P = 0.042). RVOT pacing was also associated with a lower cTnT level 6 and 24 hours after procedure (P < 0.01). Lead performance and echocardiographic parameters during follow-up revealed no difference between RV apex and RVOT pacing.
Conclusion: In patients with severe TR, the ventricular lead is more easily and steadily located at RVOT septum than at the RV apex with shorter fluoroscopy time, lower incidence of intra-procedural dislodgement and less myocardial injury.