Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them.
The permanent cardiac pacemaker is the only effective therapy for patients with symptomatic bradycardia and hundreds of millions are implanted worldwide every year. Despite its undisputed clinical benefits, the last two decades have drawn much attention to the negative effects associated with long-term pacing of the right ventricle (RV). Experimental and clinical studies have shown that RV pacing produces ventricular dyssynchrony, similar to that of left bundle branch block, with consequent detrimental effects on cardiac structure and function, with adverse clinical outcomes such as atrial fibrillation, heart failure and death. Although clinical evidence largely comes from subanalyses of pacemaker and implantable cardiac defibrillator studies, there is strong evidence that patients with reduced left ventricular function are at high risk of suffering from the detrimental effects of long-term RV pacing. Biventricular pacing in cardiac resynchronization therapy devices can prevent ventricular dyssynchrony and has emerged as an attractive option in this patient group with promising results and more clinical studies underway. Moreover, there is evidence that specific pacemaker algorithms that minimize RV pacing can reduce the negative effects of RV stimulation on cardiac function and may also prevent clinical deterioration. The extent of the long-term clinical effects of RV pacing in patients with normal ventricular function and how to prevent this are less clear and subject to future investigation.
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Finn
F
Akerström
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Marta
M
Pachón
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Alberto
A
Puchol
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Jesús
J
Jiménez-López
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Diana
D
Segovia
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
Luis
L
Rodríguez-Padial
Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain. Electronic address: maapalomares@secardiologia.es.
Miguel A
MA
Arias
D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D020257:Ventricular Remodeling / Q000502:physiology
Cardiac pacing; Cardiac resynchronization therapy; Heart failure; Implantable cardioverter defibrillator; Managed ventricular pacing; Right ventricular pacing