| Objective: To evaluate the Clinical Value of pacing in right ventricular outflow tract for patients with complete atrioventricular block, and study the clinical safety and feasibility in patients with right ventricular septal.Methods: 81 patients with complete Atrioventricular Block were installed dual-chamber permanent cardiac pacemaker. Between them, there were 48 patients were right ventricular outflow tract septal pacing group(septal group), 28 male and 20 female, with age ranging from 45 to 72(56.7±8.4)years old; there were 33 patients were right ventricular apex pacing(apex group) group, 19 male and 14 female, with age ranging from 43 to 76(58.7±10.3)years old. There was no statistic difference in clinical character between two groups. All patients had the indication of dual-chamber permanent cardiac pacemaker. The patients of septal group were performed right ventricular outflow tract septal pacing with active fixation lead. In order to improve the successful rate of electrode orientation, we made the J-conductor to double-angled tip shaping; the apex group was implanted right ventricular apex pacing. All patients were followed for 18 months after operation, we optimized the pacing parameters and monitored pacing domain regularly, observed the cardiac structure, the cardiac function ,the incidence rates of atrial fibrillation, and the quality of life dynamically.Results: (1) All patients' operations were smoothly, 81 patients were implanted pacemaker successfully. The successful rate of electrode orientation in septal group is 100%. There were no intraoperative and postoperative complication such as pericardial tamponade and pacemaker lead dislocation. After followed for 18 months, there was no death. (2) LVEF,CO,E/A decreased obviously in apex group compared with septal group, they had statistic difference (P<0.05). (3) LVEDd and LAD had an increasing trend compared with pre-operation between two groups, but there was no statistic difference (P>0.05) after 12 months. After 18 months, there was statistic difference (P<0.05) in right ventricular apex pacing group. (4) The ratio of observed/predicted left ventricular mass(%PLM)had the trend of increase compared with pre-operation. there was no statistic difference (P>0.05) in septal group, but there was statistic difference(P<0.05) in apex group.(5) There was an increase trend in SF-36 compared with pre-operation in two groups, There was no statistic difference between the two groups after 12 months (P>0.05), But had statistic difference after 18 months (P<0.05). (6) The effect of different position pace making on 6MWT after 18 months: there was no statistic difference (P>0.05) in septal group, but there was statistic difference(P<0.05) in apex group.(7) The incidence rates of atrial fibrillation is far lower in septal group than apex group, they had statistic difference (P=0.033).Conclusions: (1) It is feasible and safe in patients with right ventricular outflow tract septal pacing with active fixation lead. (2) Compared with right ventricular apex pacing, right ventricular outflow tract septal pacing can make the activation sequence much closer to normal physiologic pacing. In some extent, right ventricular outflow tract septal pacing can protect cardiac function of patients, and mitigate the deterioration of the heart function which is induced by abnormal activation sequence. (3) The influence to cardiac structure is less in Right ventricular outflow tract septal pacing than right ventricular apex pacing. (4) Right ventricular outflow tract septal pacing had less effect to the ratio of observed/predicted left ventricular mass, compared with right ventricular apex pacing.(5) The quality of life are improved both in two kinds of pacing mode. But under long-term ventricular apex pacing can affect the life quality in some extent. (6) Compared with right ventricular apex pacing, right ventricular outflow tract septal pacing can lead to the lower incidence rates of atrial fibrillation.
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