title: Physiologic pacing: new modalities and pacing sites.
abstract: Right ventricular (RV) apical pacing impairs left ventricular function by inducing dys-synchronous contraction and relaxation. Chronic RV apical pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. These observations have raised questions regarding the appropriate pacing mode and site, leading to the introduction of algorithms and new pacing modes to reduce the ventricular pacing burden in dual chamber devices, and a shift of the pacing site away from the RV apex. However, further investigations are required to assess the long-term results of pacing from alternative sites in the right ventricle, because long-term results so far are equivocal. The potential benefit of prophylactic biventricular, mono-chamber left ventricular, and bifocal RV pacing should be explored in selected patients with a narrow QRS complex, especially those with impaired left ventricular function. His bundle pacing is a promising and evolving technique that requires improvements in lead technology.
authors.affiliation: Institute of Internal Medicine and Cardiology, University of Florence, Florence, Italy. elettrofisiologia@dfc.unifi.it
authors.forename: Luigi
authors.initials: L
authors.lastname: Padeletti
authors.forename: Randy
authors.initials: R
authors.lastname: Lieberman
authors.forename: Sergio
authors.initials: S
authors.lastname: Valsecchi
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Hettrick
mesh_terms: D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000517:prevention & control*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000379:methods*; D006329:Heart Conduction System / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D018487:Ventricular Dysfunction, Left / Q000209:etiology* / Q000517:prevention & control