Mitigation of pacing-induced cardiomyopathy with superficial right ventricular midseptal pacing: Failure of stylet-driven leads to duplicate 3830 success

Pacing induced cardiomyopathy (PICM) is an established potential complication of chronic right ventricular (RV) pacing therapy. We have recently demonstrated a significant mitigation of this complication by superficial RV mid-septal (RVMS) pacing in patients with normal left ventricular function, versus standard RV apical pacing.1 The designation of superficial is utilized to differentiate this approach from the deep septal approach utilized for left bundle branch area pacing (LBBAP). This data represented the first to demonstrate a clear improvement from apical pacing, despite attempts of multiple prior studies over 20 years.