title: The importance of avoiding unnecessary right ventricular pacing in clinical practice.
abstract: Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with long-term pacing of the apex of the right ventricle (RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function (LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing (cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.
authors: Finn Akerström, Miguel A Arias, Marta Pachón, Jesús Jiménez-López, Alberto Puchol, Justo Juliá-Calvo, Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, 45004 Toledo, Spain.
authors: Finn
authors: F
authors: Akerström
authors: Miguel A
authors: MA
authors: Arias
authors: Marta
authors: M
authors: Pachón
authors: Jesús
authors: J
authors: Jiménez-López
authors: Alberto
authors: A
authors: Puchol
authors: Justo
authors: J
authors: Juliá-Calvo
keywords: Cardiac pacing; Cardiac resynchronization therapy; Heart failure; Implantable cardioverter-defibrillator; Managed ventricular pacing; Right ventricular pacing