Right ventricular apex pacing: is it obsolete?
Clinical trials in patients with pacemakers for sinus node dysfunction or atrioventricular block have highlighted the fact that desynchronization of ventricular contraction induced by right ventricular apical pacing is associated with long-term morbidity and mortality. These clinical data confirm pathophysiological results indicating that right ventricular apical pacing causes abnormal ventricular contraction, reduces pump function and leads to myocardial hypertrophy and ultrastructural abnormalities. In this manuscript, we discuss the clinical evidence for the adverse and beneficial effects of various right ventricular pacing sites, left ventricular pacing sites and biventricular pacing. We also propose a decisional algorithm for pacing modalities, based on atrioventricular conduction, left ventricular function and expected lifespan.
Sanaa
Islem
I
Unité de rythmologie, service de cardiologie, hôpital La Timone Adultes, 9e étage, 264, rue Saint-Pierre, 13385 Marseille cedex 05, France.
Franceschi
Frédéric
F
Prevot
Sébastien
S
Bastard
Emilie
E
Deharo
Jean-Claude
JC
D000465:Algorithms; D054537:Atrioventricular Block / Q000503:physiopathology / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D009200:Myocardial Contraction; D018579:Patient Selection; D018570:Risk Assessment; D012849:Sinoatrial Node / Q000503:physiopathology; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right