title: Minimizing right ventricular pacing in sinus node disease: Sometimes the cure is worse than the disease.
abstract: Traditional right ventricular (RV) apical pacing has been associated with heart failure, atrial fibrillation and increased mortality. To avoid the negative consequences of RV apical pacing different strategies have been developed, among these a series of pacing algorithms designed to minimize RV pacing. These functions are particularly useful when there is not the need for continuous RV pacing: intermittent atrio-ventricular blocks and, mainly, sinus node disease. However, in order to avoid RV pacing, the operational features of these algorithms may lead to adverse (often under-appreciated) consequences in some patients. We describe a case of a patient with sinus node disease, in whom right atrial only pacing involved long atrio-ventricular delay to allow intrinsic ventricular conduction, which led to symptomatic hypotension that could be overcome only by "forcing" also right ventricular apical pacing. We subsequently discuss this case in the context of current available literature.
authors: Elia De Maria, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy.
authors: Elia
authors: E
authors: De Maria
authors: Elia De Maria, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy.
authors: Alina
authors: A
authors: Olaru
authors: Elia De Maria, Stefano Cappelli, Cardiology Unit, Ramazzini Hospital, 41012 Carpi (Modena), Italy.
authors: Stefano
authors: S
authors: Cappelli
keywords: Dyssynchrony; Pacemaker algorithms; Pacemaker syndrome; Right atrial pacing; Right ventricular apical pacing