Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function?

作     者：Kang CHEN Ye MAO Shao-hua LIU Qiong WU Qing-zhi LUO Wen-qi PAN Qi JIN Ning ZHANG Tian-you LING Ying CHEN Gang GU Wei-feng SHEN Li-qun WU 

作者机构：Department of Cardiology Ruijin Hospital Shanghai Jiao Tong University School of Medicine Outpatient Department Shanghai Jiao Tong University School of Medicine 

出 版 物：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》 (浙江大学学报（英文版）B辑（生物医学与生物技术）)

年 卷 期：2014年第15卷第6期

页      面：507-514页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：Project supported by the National Natural Science Foundation of China(Nos.30900604 and 81270004) the Shanghai Natural Science Foundation(No.11ZR1422800) the Medical Key Project of Shanghai Science and Technology Commission(No.12411952100) the New Outstanding Youth Program of Shanghai Municipal Commission of Health and Family Planning(No.XYQ2013105),China 

主　　题：Mid-septal pacing Apical pacing Impaired heart function 

摘      要：Objective： We are aimed to investigate whether right ventricular mid-septal pacing （RVMSP） is superior to conventional right ventricular apical pacing （RVAP） in improving clinical functional capacity and left ventricular ejection fraction （LVEF） for patients with high-degree atrio-ventricular block and moderately depressed left ventricle （LV） function. Methods： Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF （ranging from 35% to 50%） were randomly allocated to RVMSP （n=45） and RVAP （n=47）. New York Heart Association （NYHA） functional class, echocardiographic LVEF, and distance during a 6-min walk test （6MWT） were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide （NT-proBNP） were measured using an enzyme-linked immunosorbent assay （ELISA） kit. Results： Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MVVT （485 m vs. 517 m） and LVEF （36.7% vs. 41.8%） were increased, but BNP levels were reduced （2352 pg/ml vs. 710 pg/ml） in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% （for all comparisons, P〈0.05）. However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. Conclusions： RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.