title: Physiological cardiac pacing: Current status.
abstract: Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It was believed to be the result of atrio-ventricular (AV) dyssynchrony and sequential pacing of the atrium and ventricle may solve these problems. However, despite maintenance of AV synchrony, the dual chamber pacemakers in different trials have failed to show its superiority over single chamber RV apical pacing in terms of death, progression of heart failure, and atrial fibrillation (AF). As a consequence, investigators searched for alternate pacing sites with a more physiological activation pattern and better hemodynamics. Direct His bundle pacing and Para-Hisian pacing are the most physiological ventricular pacing sites. But, this is technically difficult. Ventricular septal pacing compared to apical pacing results in a shorter electrical activation delay and consequently less mechanical dyssynchrony. But, the study results are heterogeneous. Selective site atria pacing (atrial septal) is useful for patients with atrial conduction disorders in prevention of AF.
authors.affiliation: RMO-cum-Clinical Tutor, Department of Cardiology, IPGME&R and SSKM Hospital, Kolkata, India. Electronic address: dradascard@rediffmail.com.
authors.forename: Asit
authors.initials: A
authors.lastname: Das
authors.affiliation: Senior Interventional Cardiologist, B. M. Birla Heart Research Centre, Kolkata, India.
authors.forename: Dhiman
authors.initials: D
authors.lastname: Kahali
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000628:therapy*; D002036:Bundle of His / Q000503:physiopathology*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D004562:Electrocardiography; D006439:Hemodynamics; D006801:Humans
keywords: Atrial septa pacing; Direct His bundle pacing; Para-Hisian pacing; Physiological pacing; Ventricular septal pacing