Right ventricular pacemaker lead position is associated with differences in long‐term outcomes and complications

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While pacing technology and approaches continue to evolve, the vast majority of cardiac pacing is still delivered by placing a lead in the right ventricle (RV), typically in the apex. RV apical pacing has been associated with negative effects on cardiac function and outcomes.1 Even a pacing burden as low as 20% recently has been associated with pacing‐induced cardiomyopathy in patients with previously normal left ventricular systolic function.3
In an attempt to minimize these negative effects, several alternative lead positions have been proposed. These other pacing sites are potentially more physiologic, with the RV septum and outflow tract being the most well studied, although the data is still confined to small cohorts4
RV apical pacing results in cardiac dyssynchrony analogous to a left bundle branch block—both in the normal and failing heart.10 Electrical activation at the RV apex results in relatively slow myocardial conduction and delayed activation of the left ventricle (LV). In contrast, RV outflow tract and/or septal pacing may facilitate more rapid activation of the LV lateral free‐wall, yet long‐term studies assessing this are not available.
The aim of this study was to compare long‐term clinical outcomes between patients based on the position of the RV lead tip. By using a retrospective design, a larger number of patients could be included and followed over a longer period of time than in many prior studies. Complication rates with various lead positions were assessed to evaluate the possibility that high rates of dislodgement or perforation might negate any practical benefit of a nonapical lead location.
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