Survival Analysis in Patients With Preserved Left Ventricular Function and Standard Indications for Permanent Cardiac Pacing Randomized to Right Ventricular Apical or Septal Outflow Tract Pacing

Alicja Dabrowska-Kugacka; Ewa Lewicka-Nowak; Sebastian Tybura; Rajmund Wilczek; Justyna Staniewicz; Pawel Zagozdzon; Anna Faran; Dariusz Kozlowski; Grzegorz Raczak; Grazyna Swiatecka

doi:10.1253/circj.CJ-09-0084

Arrhythmia/Electrophysiology

Survival Analysis in Patients With Preserved Left Ventricular Function and Standard Indications for Permanent Cardiac Pacing Randomized to Right Ventricular Apical or Septal Outflow Tract Pacing

Alicja Dabrowska-Kugacka, Ewa Lewicka-Nowak, Sebastian Tybura, Rajmund Wilczek, Justyna Staniewicz, Pawel Zagozdzon, Anna Faran, Dariusz Kozlowski, Grzegorz Raczak, Grazyna Swiatecka

Author information

Alicja Dabrowska-Kugacka
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Ewa Lewicka-Nowak
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Sebastian Tybura
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Rajmund Wilczek
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Justyna Staniewicz
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Pawel Zagozdzon
Department of Hygiene and Epidemiology, Medical University of Gdansk
Anna Faran
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Dariusz Kozlowski
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Grzegorz Raczak
Department of Cardiology and Electrotherapy, Medical University of Gdansk
Grazyna Swiatecka
Department of Cardiology and Electrotherapy, Medical University of Gdansk

Keywords: Cardiovascular death, Permanent cardiac pacing, Right ventricular apical pacing, Right ventricular outflow tract pacing, Survival

JOURNAL FREE ACCESS

2009 Volume 73 Issue 10 Pages 1812-1819

DOI https://doi.org/10.1253/circj.CJ-09-0084

View "Advance Publication" version (August 19, 2009).

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Abstract

Background: Optimal right ventricular (RV) pacing site in patients referred for permanent cardiac pacing remains controversial. A prospective randomized trial was done to compare long-term effect of permanent RV apex (RVA) vs RV outflow tract (RVOT) pacing on the all-cause and cardiovascular mortality. Methods and Results: A total of 122 consecutive patients (70 men, 69 ±11 years), with standard pacing indications were randomized to RVA (66 patients) or RVOT (56 patients) ventricular lead placement. After the 10-year follow-up period the mortality data were summarized on the basis of an intention-to-treat analysis. During the long-term follow-up, 31 patients from the RVA group died vs 24 patients in the RVOT group (hazard ratio (HR), 0.96; 95% confidence interval (CI), 0.57-1.65; P=0.89). There were 10 cardiovascular deaths in the RVA and 12 in the RVOT group (HR, 1.04; 95%CI, 0.45-2.41; P=0.93). There were no differences in the all-cause or cardiovascular mortality between the pacing sites after adjustment for age, gender, arterial hypertension, atrial fibrillation, New York Heart Association class and left ventricular end-diastolic diameter. Conclusions: The RVOT provides no additional benefit in terms of long-term survival over RVA pacing. (Circ J 2009; 73: 1812-1819)

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