Objective To investigate the impact of right ventricular septal (RVS) active fixation lead on cardiac functions in elderly patients implanted with permanent pacemakers. Methods A total of 78 patients at an average age of 71.9±6.7 implanted with permanent pacemakers in our hospital during June 2008 to May 2011 were enrolled into this study. They were divided into 2 groups according to their own will of which type of pacemaker, that is, RVS pacing group (experiment group, implanted with active fixation lead, n＝42) and right ventricular apical (RVA) pacing group (control group, implanted with passive fixation lead, n＝36). Their fractional shortening (FS), stroke volume (SV), cardiac outcome (CO), left ventricular ejection fraction (LVEF) and E/A ratio (early to late atrial ventricular filling velocity) were evaluated by echocardiography before and 6 months after implantation. Results No significant difference in cardiac functions was found between the 2 groups before implantation (P＞0.05). A trend of decrease was found in FS, SV, CO, LVEF, and E/A ratio in RVS pacing group in 6 months after implantation though without significant difference (P＞0.05). Despite that RVA pacing group had no difference in FS compared with RVS pacing group in 6 months after implantation, it had significantly higher SV, CO, LVEF, and E/A ratio (P＜0.05). There was no difference in pacing threshold, perception, impedance pacing rate, and mean heart rate between the 2 groups (P＞0.05). Conclusion RVS pacemaker implantation is superior to RVA pacemaker implantation in cardiac functions for senile patients.