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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\u003Cp id=\u0022p-1\u0022\u003ELeft ventricular septum pacing is feasible and may be an alternative site for antibradycardia pacing that avoids some of the disadvantages associated with biventricular pacing. This article reviews the early investigational research and a feasibility study supporting this potential new approach.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eantibradycardia\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eleft ventricular septum pacing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eright ventricular apex\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ELVS pacing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERVA pacing\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventricular septum\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EIVS\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ehemodynamic measurements\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\u003Cp id=\u0022p-2\u0022\u003EThe use of the left ventricular (LV) septum as an alternative site for pacing was shown to be feasible, safe, and effective, without the disadvantages associated with biventricular pacing, according to Kevin Vernooy, MD, PhD, Maastricht University Medical Center, Maastricht, The Netherlands. Work conducted by his research group, which studies LV septum (LVS) pacing, was presented at the European Heart Rhythm Association\/Cardiostim Inventors Awards session.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EConventional right ventricular apex (RVA) pacing is not ideal for most patients, because it leads to LV dyssynchrony and can result in LV dysfunction. In LVS pacing, the lead is placed using the same transvenous routes as the traditional right ventricular pacing lead, but a lead with an extended helix is placed through the interventricular septum (IVS) to pace the left side of the IVS.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EProf Prinzen\u2019s research group showed in experimental work that LVS pacing was associated with less electrical dyssynchrony and more synchronous contraction [Mills RW et al. \u003Cem\u003ECirc Arrhythm Electrophysiol\u003C\/em\u003E. 2009].\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe feasibility study presented in this session included 10 patients with sinus node dysfunction who were not dependent on ventricular pacing. The patients had an average age of 72 years; one-half were women; the average LV ejection fraction was 59%; and IVS thickness was 9 mm. All patients were in sinus rhythm with a narrow QRS complex. After the right atrial lead was placed, an angiogram of the right ventricular was performed for close visualization. A catheter delivery system (Medtronic C315 or C304) was used to position an adapted Medtronic 3830 lead with an extended helix (Medtronic 09066) perpendicular to the IVS to provide LVS. A hemodynamic (LVdp\/dt\u003Csub\u003Emax\u003C\/sub\u003E) pacing protocol was then performed 10 beats per minute above intrinsic sinus rate at the LVS, right ventricular septum (RVS; ring of LVS lead), and RVA.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003ELVS lead implantation was successful in all patients on the first attempt. During the course of the study, the time required to place the lead decreased from 90 to 12 minutes. A progressive decrease was also seen for total length of the procedure (237 to 83 minutes) and total fluoroscopy time (44 to 10 minutes). The last procedures were completed without intercardiac echocardiography.\u003C\/p\u003E\u003Cp id=\u0022p-7\u0022\u003ENo LVS lead-related complications occurred during the periprocedure period or at 6 months. Lead stability and other pacing parameters were not clinically different at 6 months vs baseline (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/16739\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/16739\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16739\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003EKey Outcomes of Left Ventricular Septum Feasibility Study\u003C\/p\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-10\u0022\u003EThe average QRS duration at 6 months was significantly shorter during LVS (144 milliseconds), as compared with RVA (172 milliseconds) and RVS (165 milliseconds) pacing (\u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.02).\u003C\/p\u003E\u003Cp id=\u0022p-11\u0022\u003EHemodynamic measurements revealed that in healthy hearts, RVA pacing reduced LVdp\/dt\u003Csub\u003Emax\u003C\/sub\u003E by 7.1% and by 6.9% with RVS as compared with normal intrinsic activation. With LVS pacing, LVdp\/dt\u003Csub\u003Emax\u003C\/sub\u003E increased significantly vs RVA and RVS pacing.\u003C\/p\u003E\u003Cp id=\u0022p-12\u0022\u003EIn conclusion, during long-term follow-up, the LVS lead remained electrically and mechanically stable, and hemodynamic measures support LVS pacing to be preferable over RVA pacing. These researchers suggest that LVS pacing has the potential to be a better approach than RVA pacing in patients who need pacing for bradycardia.\u003C\/p\u003E\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/22\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzl3n2\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzl3n2\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}