Alternative right ventricular pacing sites.
BACKGROUND
The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques of stimulation should be considered to optimize electrotherapy. One of these methods is pacing from alternative right ventricular sites.


OBJECTIVE
The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing.


METHODS
Medline and PubMed bases were used to search English and Polish reports published recently.


RESULTS
Recent studies report a deleterious effect of long term apical pacing. It is suggested that permanent apical stimulation, by omitting physiological conduction pattern with His-Purkinie network, may lead to electrical and mechanical dyssynchrony of heart muscle contraction. In the long term this pathological situation can lead to severe heart failure and death. Because of this, scientists began to search for some alternative sites of cardiac pacing to reduce the deleterious effect of stimulation. Based on current accumulated data, it is suggested that the right ventricular outflow tract, right ventricular septum, direct His-bundle or biventricular pacing are better alternatives due to more physiological electrical impulse propagation within the heart and the reduction of the dyssynchrony effect. These methods should preserve a better left ventricular function and prevent the development of heart failure in permanent paced patients. As there is still not enough, long-term, randomized, prospective, cross-over and multicenter studies, further research is required to validate the benefits of using this kind of therapy.


CONCLUSIONS
The article should pay attention to new sites of cardiac stimulation as a better and safer method of treatment.
Department of Cardiology, Wroclaw Medical University, Poland.
Dariusz
D
Łuciuk
Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Poland.
Marek
M
Łuciuk
Department of Cardiology, Wroclaw Medical University, Poland.
Jacek
J
Gajek
D000818:Animals; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D004867:Equipment Design; D006329:Heart Conduction System / Q000503:physiopathology*; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D009200:Myocardial Contraction; D010138:Pacemaker, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000209:etiology / Q000503:physiopathology; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right