Abstract: AIM: To evaluate the stability of the application of active fixation leads with right ventricular septum (RVS) pacing and to compare the hemodynamic effects of RVS pacing and right ventricular apex pacing (RVA) in patients with implanted DDD pacemakers. METHODS: There were 22 patients with implanted DDD pacemakers who were randomly divided into RVS group and RVA group. RESULTS: Impedance and amplitude of R-wave were similar during implantation between groups. The pacing threshold and electric current were significantly higher in RVS group than in RVA group; however, these differences disappeared at 1 month post-pacemaker implantation. Mean QRS duration was shorter in RVS group than in RVA group (P<0.05). RVS group had longer X-ray exposure than RVA group (P<0.05). Left ventricular ejection fraction (LVEF), cardiac index (CI), stroke volume (SV), and mitral E/A ratio (E/A) were higher in RVS group than in RVA group at 6 months post-pacemaker implantation, but there were no preoperative differences. CONCLUSION: Pacing at right ventricular outflow was safe and efficient. RVS pacing was more effective according to hemodynamic effects than RVA pacing.