Alternative right ventricular pacing sites — where are we going?

Harris, Z. I.; Gammage,

doi:10.1053/eupc.2000.0081

Cited by 7 publications

(3 citation statements)

References 50 publications

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“…119 The clinical effects of RVOT pacing have been recently reviewed elsewhere in more detail. 122 Beside the RVOT, LV pacing sites become increasingly popular, especially since newly developed leads for transcoronary venous approach makes pacing of the LV epicardium clinically feasible. 123 LV function is consistently better when pacing LV sites than when pacing RV sites (Table III).…”

Section: Search For the Optimal Pacing Site(s)mentioning

confidence: 99%

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

Prinzen

Peschar

2002

Pacing Clinical Electrophis

251

195

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The main goal of this article was to review animal experimental work on the effect of asynchronous activation on ventricular pump function. During normal sinus rhythm and atrial pacing, the Purkinje system contributes significantly to the rapid electrical activation of the ventricles. In contrast, during ventricular pacing the impulse is almost exclusively conducted through the normal myocardium. As a consequence, electrical activation of the ventricles becomes asynchronous and has an abnormal sequence. The abnormal impulse conduction causes considerable disturbances to occur in regional systolic fiber shortening, mechanical work, blood flow, and oxygen consumption; low values occurring in early activated regions and values above normal being present in late activated regions. Many animal studies have now shown that the abnormal electrical activation, induced by ventricular pacing, leads to a depression of systolic and diastolic LV function. Pacing at the right ventricular apex (the conventional pacing site) reduces LV function more than pacing at the high ventricular septum or at LV sites. In canine hearts with experimental LBBB, LV pacing significantly improves LV pump function. Differences in LV pump function between (combinations of) pacing sites are poorly correlated with QRS duration. Therefore, the cause of the depression of LV function during abnormal electrical activation appears to be a combination of the asynchrony and the sequence of activation. These experimental findings justify continuing attention for optimizing the site(s) of ventricular pacing in patients with normal and abnormal ventricular impulse conduction.

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Section: Search For the Optimal Pacing Site(s)mentioning

confidence: 99%

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

Prinzen

Peschar

2002

Pacing Clinical Electrophis

251

195

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“…This in turn may improve atrial hemodynamics and reduce the incidence of paroxysmal atrial tachyarrhythmias like atrial fibrillation 14 . In the ventricles, the expected improvements from a more physiological depolarization pattern include better hemodynamics, 15 less mitral valve regurgitation, less detrimental remodeling, 16 and delaying, reducing, or eliminating long‐term negative changes like perfusion defects and heart failure 17 …”

Section: Traditional and Selective Pacing Sitesmentioning

confidence: 99%

Selective Site Pacing:

Lieberman

Grenz

Mond

et al. 2004

Pacing Clinical Electrophis

112

106

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Selective site right ventricular pacing has been suggested as an approach to reduce the incidence of ventricular dysfunction and hopefully influence the morbidity resulting from traditional right ventricular apical pacing. Pacing from the right ventricular apex allows a stable ventricular rate, and together with atrial pacing and sensing, helps maintain atrioventricular synchrony but does not allow physiological activation of the left ventricle. Traditional atrial pacing sites like the right atrial appendage may encourage atrial tachyarrhythmias, whereas lead placement in right atrial septal sites may reduce the frequency of symptomatic atrial tachyarrhythmia episodes, especially when combined with prevention algorithms. Researchers attempting to pace the heart from these selective sites have been hindered by the lack of uniform definitions of where these sites actually lie and the inadequacy of tools to consistently reach these locations and verify correct placement. This lack of definition consensus may have contributed to the apparent conflict of data, particularly in the right ventricle. There is an urgent need for a standardization of terms and identifying measures for selective pacing sites.

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“…It reflects the fact that the site is selected by the implanter in expectation of a more physiological depolarisation pattern and better haemodynamic response,19 with less detrimental remodelling,20 and reduced long-term complications such as perfusion defects and heart failure 21…”

Section: Selective Site Right Ventricular Pacingmentioning

confidence: 99%

Selective site right ventricular pacing

Albouaini

Alkarmi

Mudawi

et al. 2009

Heart

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The right ventricular apex (RVA) has been the elective site for placing endocardial pacing leads since 1959 when Furman described the use of the transvenous route for pacemaker implantation. This site was used because it is easily accessible, readily identified and associated with a stable position and reliable chronic pacing parameters. It was recognised, however, that pacing from the RVA did not reproduce normal ventricular conduction or contraction. With the advent of reliable active fixation leads, alternative right ventricular sites became accessible and began to be explored. In this review, the detrimental effects of RVA pacing are outlined, the right ventricular outflow tract is defined and the evidence for selective site pacing is discussed.

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Alternative right ventricular pacing sites — where are we going?

Cited by 7 publications

References 50 publications

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

Relation Between the Pacing Induced Sequence of Activation and Left Ventricular Pump Function in Animals

Selective Site Pacing:

Selective site right ventricular pacing

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