# Right Atrial Septal Lead Enhances the Favorable Effects of the Adaptive Cardiac Resynchronization Therapy Algorithm

## TL;DR

Placing a pacemaker lead in the right atrial septum improves the effectiveness of cardiac resynchronization therapy.

## Contribution

This study shows that right atrial septal pacing increases synchronized left ventricular pacing rates in cardiac resynchronization therapy.

## Key findings

- Patients with right atrial septal pacing had significantly higher sLVP rates compared to those with appendage pacing.
- The benefit of septal pacing was more evident in patients with first-degree atrioventricular blocks.
- Higher sLVP rates suggest better synchronization and potentially improved heart function.

## Abstract

The adaptive cardiac resynchronization therapy (CRT) algorithm provides synchronized left ventricular pacing (sLVP). However, ensuring a high sLVP rate is challenging. We assessed the association between the sLVP rate and pacing sites in the right atrium. We evaluated 71 patients who underwent CRT and in whom the adaptive CRT algorithm was applied (53 men; mean age, 66 ± 14 years; median follow-up period, 301 days; IQR: 212-596 days). The atrial pacing leads were positioned in the right atrial (RA) septum in 17 patients (septal group) and in the RA appendage in 54 patients (RA appendage group), with significantly higher sLVP rates in the septal group compared with the RA appendage group (81% ± 30% vs 63% ± 37%; P = 0.045). In patients with first-degree atrioventricular blocks, the sLVP rates tended to be higher in the septal group. Therefore, RA septal pacing increased sLVP rates in patients undergoing CRT.