Comparison of efficacy of left ventricular apical septal pacing versus basal septal pacing
Objective To compare the therapeutic efficacy of left ventricular apical septal pacing(LVASP)versus left ventricular basal septal pacing(LVBSP)in patients with sick sinus syndrome who failed left bundle branch pacing,and to provide a basis for the selection of treatment plans.Methods From December 2019 to October 2021,40 patients with sick sinus syndrome and baseline QRS duration(QRSd)＜120 ms who failed left bundle branch pacing were treated in Fuwai Central China Cardiovascular Hospital,and were divided into LVASP group(n=20)and LVBSP group(n=20).The distance between the right ventricular septal electrode implantation site and the tricuspid septal valve,the electrode implantation depth in interventricular septum,and the thickness of interventricular septum at the electrode implantation site were compared between two groups 1 week after pacing.The pacing parameters(threshold,perception,impedance)were compared between two groups during pacing and 1 week,3 months and 6 months after pacing.The QRSd and left ventricular activation time(LVAT)in lead V5 were recorded by 12-lead electrocardiogram(ECG)and intracavitary electrocardiography during pacing.The QRSd was recorded by 12-lead ECG before pacing and in pacing state 1 week,3 months and 6 months after pacing,and peak strain dispersion(PSD)was recorded by echocardiography.A follow-up survey was done for 6 months to record the occurrence of pacemaker related complications,readmission due to recurrent heart failure,and survival in two groups.Results The distance from the right ventricular septal electrode implantation site to the tricuspid septal valve was longer in LVASP group[(37.68±8.48)mm]than that in LVBSP group[(16.52± 2.55)mm](t=10.676,P＜0.001),and there were no significant differences in the electrode implantation depth in interventricular septum and the thickness of the ventricular septum at the electrode implantation site between two groups(P＞0.05).There were no significant differences in the pacing thresholds[(0.67±0.19),(0.67±0.12),(0.65± 0.11),(0.62±0.21)V/0.4 ms],perception values[(13.05±3.25),(13.99±3.59),(15.41±3.56),(16.14± 5.61)mV]and impedance values[(742.00±172.40),(588.80±82.28),(570.55±73.18),(560.55±93.94)Ω]in LVASP group compared with those in LVBSP group[pacing thresholds:(0.66±0.14),(0.65±0.18),(0.64±0.11),(0.67±0.16)V/0.4 ms;perception values:(13.11±3.00),(12.87±3.80),(13.81±4.11),(14.84±4.51)mV;impedance values:(764.05±160.90),(623.30±99.66),(584.60±68.30),(598.30±74.11)Ω]during pacing,and 1 week,3 months and 6 months after pacing(P＞0.05).There were no significant differences in the pacing thresholds 1 week,3 months and 6 months after pacing compared with those during pacing in two groups(P＞0.05).The perception value was higher 3 and 6 months after pacing than that during pacing in LVASP group(P＜0.05),and showed no significant difference 1 week after pacing compared with that during pacing(P＞0.05).In LVBSP group,the perception value showed no significant difference 1 week,3 months and 6 months after pacing compared with that during pacing(P＞0.05).The impedance values were lower 1 week,3 months and 6 months after pacing than those during pacing in two groups(P＜0.05),and showed no significant differences 1 week,3 months and 6 months after pacing(P＞0.05).The LVAT was shorter in LVASP group[(56.20±12.31)ms]than that in LVBSP group[(71.75±15.16)ms](t=3.561,P＜0.001).There was no significant difference in the QRSd between LVASP group[(95.20±14.29)ms]and LVBSP group[(95.60±14.38)ms]before pacing(P＞0.05).The QRSd values were longer in LVASP group[(136.95±17.80),(138.65±18.59),(137.25±16.81),(136.60±17.11)ms]than those in LVBSP group[(115.95±16.31),(114.95±16.37),(116.35±14.89),(116.50±13.41)ms]during pacing and 1 week,3 months and 6 months after pacing(P＜0.05),which were longer than those before pacing in two groups(P＜0.05).There was no significant difference in the PSD between LVASP group[(53.35±7.55)ms]and LVBSP group[(53.95±8.97)ms]before pacing(P＞0.05).The PSD values were smaller in LVASP group[(62.05±11.72),(63.95±10.45),(63.45± 13.00)ms]than those in LVBSP group[(71.15±12.27),(71.35±11.18),(71.55±10.81)ms]1 week,3 months and 6 months after pacing(P＜0.05),which were larger than those before pacing in two groups(P＜0.05).The 6-month follow-up showed no pacemaker related complications,readmission due to recurrent heart failure or death.Conclusions The pacing parameters are stable with no adverse events in the short term after LVASP and LVBSP in patients with sick sinus syndrome who have failed the left bundle branch pacing.The heart mechanical synchrony of LVASP is better than that of LVBSP,and can be regarded as an alternative treatment.
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