Bilateral septal pacing in combination with coronary venous pacing for cardiac resynchronization therapy.

Abstract

Conventional right ventricular pacing combined with coronary venous pacing (CVP) is a mainstay for cardiac resynchronization therapy (CRT). However, QRS duration of conventional CRT may be frequently more than 130ms. This study aimed to evaluate the effectiveness of QRS narrowing by bilateral septal pacing (BSP) in combination with CVP for CRT (BSP-CRT). Fourteen patients with QRS>130ms of conventional CRT after failure of physiological conduction system pacing were enrolled. Electrophysiologic characteristics were compared among different modes of CRT during procedure. BSP which was defined as capture of both sides of interventricular septum manifested as shortened R wave peak time without a right bundle branch block QRS pattern. BSP-CRT were successfully achieved in 85.7% (12/14) patients. QRS duration at baseline was 185±13ms and significantly narrowed to 156±9ms during conventional CRT (n=14, P<.001), to 143±7ms during left ventricular septal pacing (LVSP) in combination with CVP for CRT (LVSP-CRT) (n=9, P<.001), and further to 122±10ms during BSP-CRT (n=12, P<.001). Notably, among 7 patients in whom both LVSP and BSP were achieved, BSP-CRT outperformed LVSP-CRT at QRS narrowing by 16% (P<.001). At 3-month follow-up, left ventricular ejection fraction improved from 29±6% to 41±8% (P<.001). BSP-CRT resulted in superior acute electrical synchronization to conventional CRT and might be considered as an alternative to conventional CRT with QRS more than 130ms.