title: Future easy and physiological cardiac pacing.
abstract: The right atrial appendage (RAA) and right ventricular apex (RVA) have been widely considered as conventional sites for typical dual-chamber atrio-ventricular cardiac (DDD) pacing. Unfortunately conventional RAA pacing seems not to be able to prevent atrial fibrillation in DDD pacing for tachycardia-bradycardia syndrome, and the presence of a left bundle branch type of activation induced by RVA pacing can have negative effects. A new technology with active screw-in leads permits a more physiological atrial and right ventricular pacing. In this review, we highlight the positive effects of pacing of these new and easily selected sites. The septal atrial lead permits a shorter and more homogeneous atrial activation, allowing better prevention of paroxysmal atrial fibrillation. The para-Hisian pacing can be achieved in a simpler and more reliable way with respect to biventricular pacing and direct Hisian pacing. We await larger trials to consider this "easy and physiological pacing" as a first approach in patients who need a high frequency of pacing.
authors.affiliation: Eraldo Occhetta, Miriam Bortnik, Paolo Marino, Division of Cardiology, "Maggiore della Carità" Hospital, University of Eastern Piedmont, 28100 Novara, Italy.
authors.forename: Eraldo
authors.initials: E
authors.lastname: Occhetta
authors.forename: Miriam
authors.initials: M
authors.lastname: Bortnik
authors.forename: Paolo
authors.initials: P
authors.lastname: Marino