Is there a right place to pace the right ventricle? Evaluation of apical and septal positions in a pacemaker population: Study protocol for a prospective intervention-control trial.

Introduction: The main objective of research in pacemaker therapy has been to provide the bestphysiologic way to pace the heart. Despite the good results provided by right ventricular pacingminimization and by biventricular pacing in specific subsets of heart failure patients, these optionspresent many limitations for standard pacemaker recipients. In these patients, pacing the rightventricle at alternative sites could result in a lower degree of left intraventricular dyssynchrony.Despite the lack of strong evidence and the difficulty in placing and accurately classifying the finallead position, pacing at alternative right ventricular sites seems to have become a standardprocedure at many implanting centers.Material and methods: The RIGHT PACE study is a multi-center, prospective, single-blind, doublearm,intervention-control trial comparing right ventricular pacing from the apex and from theseptal site in terms of left intraventricular dyssynchrony. A total of 408 patients with indicationsfor cardiac pacing but without indications for ICD and/or CRT will be enrolled. Investigators will bedivided on the basis of their prior experience of selective site pacing lead implantation andpatients will be treated according to the clinical practice of the centers. After device implantation,they will be followed up for 24 months through evaluation of clinical, echocardiographic andsafety/system-performance variables.Discussion: This study might provide important information about the impact of the rightventricular pacing on the left ventricular dyssynchrony, and about acute and chronic responses toselective site pacing, as adopted in current clinical practice.