| Objective:To evaluation a randomized and double-blind controlled study by using the operating test parameters, ECG, color Doppler, the Minnesota living with heart failure score and 6-minute walk test and other indicators. Right ventricular pacing in the median septum with active fixation lead is better than right ventricular apical pacing in operation feasibility and safety.Methods:42 patients who were to be implanted a permanent pacemaker and diagnosis of sick sinus syndrome (SSS) and atrioventricular block (AVB) in the first hospital of Lanzhou university from November 2009 to June 2010 were random-controlled divide into the right ventricular mid-septal pacing group (RVSP group, n=21)and right ventricular apical pacing group (RVAP group, n=21). Active fixation leads were planted in the median septum of right ventricular with X-ray imaging position and electrocardiogram QRS wave group which changes with characteristic morphological. X-ray exposure time, parameters of leads implantation, and postoperative electrocardiogram, color Doppler and three-month follow-up general information, the Minnesota Heart Failure quality of life score and 6-minute walk test(6-MWT) were record in results.Results:All patients were successfully completed the implant operation. There was no case of lead dislocation, high pacing thresholds or inadequate sensing and pacemaker-related infection. Operation exposure time which spended in implanting the ventricular wire was not significant difference with statistically for two groups (P>0.05). QRS wave form after ventricular pacing were morphological diversification with stable characteristic in patients, and the X-ray images were discribed precise position in the right ventricular pacing in the median septum group. After pacing QRS duration in RVAP group was longer than in RVSP group significantly (90.48±20.61 and 127.62±16.09, P<0.01). There was no difference in R wave height during leads implantation (10.61±5.08 and 9.32±3.48, P>0.05). RVAP were better than RVSP in stimulation threshold, electric current and impedance with significant difference (RVSP and RVAP is 0.65±0.21 and 0.50±0.16 V,0.92±0.41mA and 0.51±0.27mA,647.77±140.34 and 751.09±175.64, respectively, P<0.05). There was statistically different in stimulation threshold comparison after operation three-month for two groups (P<0.05), but it showed the trend of decrease in period of follow-up. SPWMD, IVMD, left ventricular septal and lateral wall basal compared with the middle peak time, peak ejection rate and rapid onset time there were significant differences, which were measured by TDI. Although, there is no statistically significant difference in Minnesota quality of life table and 6 minute walking test scores, but RVSP group were still better than RVAP group.Conclusion:The location of right ventricular pacing in the median septum should be used greater in clinical practice without serious complications. X-ray images was used to distinguish position in ventricular septum area, active fixation wire can accurately and quickly locate in place. Operating X-ray exposure time which was used by ventricular wire fixed was shorter in RVSP group. Pacing QRS wave duration was narrower, Color Doppler measures of inter left and right ventricular or intra left ventricular synchronization were better, stable three-month follow-up wire test parameters, no dislocation and pacing or sensing broken.
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