Feasibility and effect of para-right bundle branch pacing in patients with atrial fibrillation and complete atrioventricular block.

BACKGROUND

Chronic right ventricular apex (RVA) pacing can induce negative clinical effects. The aim of the present study was to compare RVA pacing with para-right bundle branch (para-RBB) pacing in terms of electrocardiogram (ECG) and echocardiographic (ECHO) features.

METHODS

Forty-one consecutive persistent atrial fibrillation patients with an indication for permanent pacing treatment due to complete atrioventricular block were randomly assigned to receive a screw-in lead either in the RVA (n = 22) or at the para-RBB (n = 19). Para-RBB pacing leads were located according to the RBB potential recorded by electrophysiology catheter. ECG was recorded before and after implantation. All patients underwent the pacemaker programming at 1 day, 6 months, 12 months and 24 months after implantation. ECHO examination was performed during follow-up at 6, 12 and 24 months after implantation to assess the heart function and synchronism.

RESULTS

There was no significant difference in pacing lead parameters between para-RBB pacing group and RVA pacing group. Compared with RVA pacing group, the para-RBB pacing group obtained a narrower QRS complex, more synchronic ventricular systole, and less negative effect on heart function (p < 0.05).

CONCLUSIONS

Para-RBB pacing has potential clinical benefits and may be a physiological pacing site.