Effect of Alternative Pacing Sites between the Right Ventricular Apex and Septum in Heart Failure with a Preserved Ejection Fraction

Background: To examine the effect of pacing sites on heart failure, we evaluated the brain natriuretic peptide (BNP) level and hospitalizations for heart failure. Methods: A total of 90 patients (mean age 77±9 years, 43 men) with newly implanted pacemakers (sick sinus syndrome, n = 21; atrioventricular block, n = 69) were divided into two groups according to the pacing site: RV apical pacing group (RVA group, n = 46) and RV septal pacing group (RVS group, n = 44). All patients had a preserved LV function and more than a 90% cumulative percent ventricular pacing. We performed BNP measurements annually and at the clinical follow-ups (mean duration 3.0 years). Results: Compared with the RVS group, in the RVA group the QRS duration was prolonged (162±14ms vs. 147± 17ms, p<0.05). However, there was no significant difference in the BNP levels at 1 year (141±141pg/mL vs. 119±139pg/mL, p=NS) and δ BNP, the difference in the BNP levels between post-implantation and 1 year (-29 ±103pg/mL vs. 0±107pg/mL, p=NS). For hospitalization for heart failure, there was no significant difference between the groups (4.4% vs. 6.8%, p=NS). Conclusions: In patients with a preserved LV function, RVS or RVA pacing sites might not correlate with the heart failure.