Alternative right ventricular pacing sites--where are we going?

ArticleinEuropace 2(2):93-8 · May 2000with7 Reads
DOI: 10.1053/eupc.2000.0081 · Source: PubMed
    • "Site selection also allows minimization of far-field right wall sensing. In the ventricles, expected improvements from a more physiologic depolarization pattern include better hemodynamics [61], less mitral valve regurgitation and less remodeling [73], as well as delaying, reducing, or eliminating long-term negative changes such as perfusion defects and heart failure [55,70]. Numerous acute and chronic clinical studies have been conducted to compare the hemodynamic differences between RV apical and RVOT paced patients, yet, the results vary. "
    [Show abstract] [Hide abstract] ABSTRACT: A B S T R A C T The right ventricular (RV) apex has been used as the traditional pacing site since the development of transvenous pacing in 1959. Some studies suggest that pacing the RV apex may cause an "iatrogenic" left bundle branch block and remodeling of the left ventricle and is therefore harmful. In the past decade, the need for alternate site pacing became imperative and there have been a multitude of studies of the hemody- namic, electrophysiological, electrocardiographic, and clinical effects of ventricular pacing at other sites. Pacing of the left ventricle singly or with biventricular pacing has emerged as an effective and safe therapy for moderate to severe congestive heart failure in patients with prolonged QRS complexes. Studies of alternate RV sites, like the RV outflow tract, have given mixed results, and further clarification of the specific sites of the RV outflow tract is needed. Direct His-bundle pacing is an attractive alter- nate pacing site because of the possible hemodynamic benefits that could be obtained by a normal activation sequence, but the small size and anatomic position of the His bundle have made this approach difficult. Bifocal RV resynchronization therapies have been used as an alternative to biventricular pacing. I N T R O D U C T I O N ABBREVIATIONS AND ACRONYMS AV: atrioventricular CRT: cardiac resynchronization therapy ECG: electrocardiogram EF: ejection fraction HF: heart failure ICD: implantable cardioverter defibrillator IVCD: intraventricular conduction delay LBBB: left bundle branch block
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