Abstract 18240: Septal Pacing Improves Prognosis in Patients with High Pacemaker Dependency: A Propensity-matched Analysis
Background: The effect of septal pacing as opposed to apical pacing on prognosis in patients undergoing pacemaker implantation still remains controversial.
Methods: A total of 685 patients who have received their first pacemaker implantation from year 2008 to 2013 at 2 centers in Japan (50.4% male, age 75.3±10.6 years, 33.3% septal pacing) were analyzed. The primary endpoint was combined endpoint of all cause death and hospitalization due to heart failure, and the median follow-up period was 795 days (interquartile range, 407-1369 days). A propensity-matched analysis successfully matched 438 patients into two groups (septal pacing and apical pacing groups) resulting in 219 patients in each group with well-balanced baseline characteristics.
Results: The primary endpoint was observed in 63 patients (14.4%) in the matched cohort with marginal improvement of prognosis in septal pacing group (hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.27-1.02; P=0.056). In subgroup analysis, significant interaction was observed for characteristics of complete AV block (CAVB) at baseline (P=0.005 for interaction), history of atrial fibrillation (AF) (P=0.020 for interaction), and percent ventricular pacing (%VP)≧90% (P=0.042 for interaction), with greater reduction of primary endpoint with septal pacing in patients with CAVB (HR, 0.24; 95% CI, 0.09-0.63; P=0.004), without history of AF (HR, 0.46; 95% CI, 0.24-0.90; P=0.022), and %VP≧90% (HR, 0.41; 95% CI, 0.20-0.89; P=0.015).
Conclusion: In conclusion, improvement of prognosis with septal pacing was marginal in patients with pacemaker implantation, but was significant in subgroup of patients with CAVB, without history of AF, and high %VP who are thought to have high pacemaker dependency.
Author Disclosures: A. Mizukami: None. Y. Matsue: None. Y. Naruse: None. S. Kowase: None. K. Kurosaki: None. M. Suzuki: None. A. Matsumura: None. A. Nogami: None. K. Aonuma: None. Y. Hashimoto: None.
- © 2014 by American Heart Association, Inc.