Thresholds and Complications with Right Ventricular Septal Pacing Compared to Apical Pacing

Background: Right ventricular septal pacing has been proposed as an alternative to apical pacing. However, data concerning thresholds and requirement for lead repositioning with this technique are scant.
Methods: We reviewed data at implantation and follow-up of 362 consecutive recipients of the same model of active fixation lead (Medtronic 5076-58, Minneapolis, MN, USA) to avoid differences due to lead characteristics. Patients were divided into two groups according to whether the lead was positioned on the interventricular septum (n = 157) or at the right ventricular apex (n = 205). Thresholds, lead impedance, and requirement for lead repositioning were compared between groups at implantation and follow-up.
Results: There were no differences between the septal and apical groups in sensing and pacing thresholds or lead impedance, either at implantation or during a 24-month follow-up. In the septal group, the lead had to be repositioned in four patients (2.5%) due to lead dislodgement in two patients, acute threshold rise in one patient, and pericardial effusion in another patient (the lead had unintentionally been positioned on the anterior free wall in these last two patients). In the apical group, the lead had to be repositioned in eight patients (3.9%, P = 0.56) due to lead dislodgement in three patients and acute threshold rise in five patients.
Conclusions: Acute and chronic thresholds associated with septal pacing are similar to those observed with apical pacing, and risk of lead dislodgement is low. However, multiple radioscopic views must be used to avoid inadvertent positioning of the lead on the anterior free wall .