Selective site pacing: rationale and practical application.
Although it has become traditional to place permanent pacemaker leads at the right ventricular apex and right atrial appendage, pacing from these locations poorly mimics normal physiology. A growing evidence base shows that right ventricular apical pacing results in ventricular dyssynchrony and various adverse effects. Provocative data from early trials suggest that pacing from alternate sites in the right ventricle--His bundle pacing, para-Hisian pacing, septal right ventricular outflow tract pacing, and right ventricular midseptal pacing--may lead to improved results. Similarly, early data suggest that right atrial pacing near Bachmann's bundle may lead to superior outcomes when compared with pacing from the right atrial appendage. Several large-scale, randomized clinical trials are now under way to establish the future role of selective site pacing.
Parekh
Sameer
S
Division of Cardiology, Cornell University Medical Center, 520 East 70th Street, Starr-4, New York, NY 10065, USA.
Stein
Kenneth M
KM
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D002036:Bundle of His; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D006325:Heart Atria; D006352:Heart Ventricles; D006801:Humans; D010138:Pacemaker, Artificial / Q000009:adverse effects; D011859:Radiography; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome