title: Focus on right ventricular outflow tract septal pacing.
abstract: Experimental and clinical studies have shown that right ventricular apical pacing may result in long-term deleterious effects on account of its negative impact on left ventricular remodeling through desynchronization. This risk appears more pronounced in patients with even moderate left ventricular dysfunction and generally occurs after at least 1 year of pacing. As right ventricular apical pacing may be associated with the development of organic mitral insufficiency, other sites that allow for more physiological stimulation, such as right ventricular outflow tract septal pacing, have been developed, with good feasibility and reproducibility. However, the prospective randomized studies and meta-analyses to date have only demonstrated a modest effect on ejection fraction in the medium term, without any significant effect on quality of life and morbimortality. However, the absence of a favorable effect for right ventricular outflow tract septal pacing compared with right ventricular apical pacing in terms of clinical manifestations and patient prognosis appears to be more associated with the designs of these studies, which were not homogeneous with regard to methodology used, judgment criteria, follow-up and, especially, statistical power. Two randomized prospective multicentre studies are currently ongoing in order to evaluate the favorable effect of infundibular septal pacing, when considering the indirect negative effects of right ventricular apical pacing as reported in the literature.
authors.affiliation: Service de Cardiologie, Université Jean Monnet, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, France. dakosta@aol.com
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Laurent
authors.initials: L
authors.lastname: Gabriel
authors.forename: Cécile
authors.initials: C
authors.lastname: Romeyer-Bouchard
authors.forename: Bertaux
authors.initials: B
authors.lastname: Géraldine
authors.forename: Alexie
authors.initials: A
authors.lastname: Gate-Martinet
authors.forename: Bisch
authors.initials: B
authors.lastname: Laurence
authors.forename: Marie
authors.initials: M
authors.lastname: Levallois
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D004554:Electric Countershock / Q000295:instrumentation; D004867:Equipment Design; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D010138:Pacemaker, Artificial; D013318:Stroke Volume; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology / Q000628:therapy; D016278:Ventricular Function, Right; D054088:Ventricular Septum / Q000503:physiopathology*
keywords: AF; Apical pacing; CRT; DDD; Defibrillator; Défibrillateur; EF; HR; Infundibular pacing; LV; LVEF; Pacemaker; RV; RVAP; RVOT; Septal pacing; Stimulation apicale; Stimulation infundibulaire; Stimulation septale; VVI; atrial fibrillation; cardiac resynchronization therapy; dual-chamber pacemakers; ejection fraction; hazard ratio; left ventricle; left ventricular ejection fraction; right ventricle; right ventricular apical pacing; right ventricular outflow tract; single-chamber ventricular pacing