Selective site ventricular pacing

McGavigan, Andrew D.; Mond, Harry G.

doi:10.1097/01.hco.0000198981.48013.70

Cited by 22 publications

(19 citation statements)

References 54 publications

(102 reference statements)

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“…As an alternative strategy, RV outflow tract pacing has been performed, [9][10][11] whereas its procedure may be considered to be associated with a high threshold and low sensing. 18) Additionally, the anatomical accuracy for RV outflow tract is poor and several reports have used inconsistent pacing sites: RV outflow tract free wall or septum.…”

Section: Discussionmentioning

confidence: 99%

“…7,8) Recently, selective site pacing (SSP), where alternate sites for ventricular pacing are used, has come into use to improve ventricular dyssynchrony. [9][10][11] In SSP, His-bundle or para-His pacing 12,13) and a procedure where a ventricular lead is positioned in the RV outflow tract have been used. [14][15][16] The former involves technical difficulties, whereas the latter has produced unsatisfactory longterm effects and also poses a high risk of complications such as pericardial effusion.…”

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confidence: 99%

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Selective Site Pacing From the Right Ventricular Mid-Septum

et al. 2012

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SummaryPacing from the right ventricular (RV) apex is associated with adverse effects such as heart failure and atrial fibrillation. We attempted pacing from the RV mid-septum, which is theoretically a more physiological pacing site. A total of 172 consecutive patients with indications for permanent pacemaker implantation were studied. A screw-in lead and a curved stylet were used for lead positioning on the RV mid-septum. Pacemaker indices were evaluated at implantation and one year later. As an electrocardiographic parameter, QRS duration was measured in lead II. These data were compared to those of 66 patients subjected to conventional RV apical pacing. Lead placement was successful in all patients of RV mid-septal pacing. There were no technical problems during or after the procedure. The cumulative percentage of ventricular pacing at one year postimplantation was 85 ± 24 % in the SSP group. Sensing, pacing threshold, and lead impedance in the SSP group remained clinically stable over one year. When these measurements were compared between the SSP and AP groups, the pacing threshold and the lead impedance at one year postimplantation in the SSP group were higher (P < 0.05) and lower (P < 0.01), respectively, than those of the AP group. The mean QRS duration was markedly shorter (123 ± 16 versus 150 ± 18 msec, P < 0.0001). Selective site pacing from the RV mid-septum is feasible and results in less conduction delay compared to conventional RV apical pacing, and its procedure seems to be more physiological in permanent pacemaker implantation. (Int Heart J 2012; 53: 113-116) Key words: Pacing procedure, Selective site pacing, Physiological pacing, Right ventricular mid-septal pacing, Pacemaker implantation T he mainstream of pacing treatment for bradyarrhythmia has been pacing from the right ventricular (RV) apex, which has been regarded as physiological pacing, to maintain atrioventricular synchrony. However, with conventional RV apex pacing, the impulse is conducted from the apex to the base of the heart and from the right to the left ventricles, and therefore the time for impulse conduction in the ventricles is significantly prolonged.1,2) This procedure is reported to cause ventricular dyssynchrony, 3,4) resulting in an increased risk for occurrence of heart failure 5-7) or atrial fibrillation. 7,8) Recently, selective site pacing (SSP), where alternate sites for ventricular pacing are used, has come into use to improve ventricular dyssynchrony. 9-11)In SSP, His-bundle or para-His pacing 12,13) and a procedure where a ventricular lead is positioned in the RV outflow tract have been used.14-16) The former involves technical difficulties, whereas the latter has produced unsatisfactory longterm effects and also poses a high risk of complications such as pericardial effusion. 17)In this study, we evaluated the efficacy and safety of SSP in patients in whom RV leads were positioned in the middle of the RV septum (mid-septum) and compared it with conventional RV apex pacing. We also examined points to obtain f...

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Selective Site Pacing From the Right Ventricular Mid-Septum

et al. 2012

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“…3 Results of acute and chronic studies show mixed results with a tendency toward better hemodynamic outcome when pacing at these alternative sites. 4 However, much uncertainty is present, due to poor definition of the exact pacing site, the limited number of hemodynamic parameters studied, and nonrandomized studies. Of the 5 chronic studies referred to in Reference 4, 2 demonstrated a significant benefit of RV septal over RV apical pacing.…”

Section: Rv Apical Versus Rv Midseptal Pacingmentioning

confidence: 99%

“…Of the 5 chronic studies referred to in Reference 4, 2 demonstrated a significant benefit of RV septal over RV apical pacing. 4 In 1 of these studies, RV septal pacing produced a shorter QRS duration, whereas in the other positive study, the septum was mapped to achieve the shortest QRS duration. 25,26 In the present study, the lead was implanted in the RV midseptum, based solely on position and not optimizing the QRS complex.…”

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“…Because pacing leads are usually implanted transvenously, alternate sites within the RV have been studied most intensively, but results of the various studies are mixed. 3,4 Experimental and clinical studies indicate that LV pacing sites often render better hemodynamic performance than RV pacing sites. [5][6][7] In a previous acute canine study, we observed hemodynamic benefits by LV septal and LV apical pacing, compared with RV apical pacing, and mixed effects during RV septal pacing.…”

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Left Ventricular Septal and Left Ventricular Apical Pacing Chronically Maintain Cardiac Contractile Coordination, Pump Function and Efficiency

Mills

Cornelussen

Mulligan

et al. 2009

Circ: Arrhythmia and Electrophysiology

105

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Background-Conventional right ventricular (RV) apex pacing can lead to adverse clinical outcome associated with asynchronous activation and reduced left ventricular (LV) pump function. We investigated to what extent alternate RV (septum) and LV (septum, apex) pacing sites improve LV electric activation, mechanics, hemodynamic performance, and efficiency over 4 months of pacing. Methods and Results-After AV nodal ablation, mongrel dogs were randomized to receive 16 weeks of VDD pacing at the RV apex, RV septum, LV apex, or LV septum (transventricular septal approach). Electric activation maps (combined epicardial contact and endocardial noncontact) showed that RV apical and RV septal pacing induced significantly greater electric desynchronization than LV apical and LV septal pacing. RV apex and RV septal pacing also significantly increased mechanical dyssynchrony, discoordination (MRI tagging) and blood flow redistribution (microspheres) and reduced LV contractility, relaxation, and myocardial efficiency (stroke work/myocardial oxygen consumption). In contrast, LV apical and LV septal pacing did not significantly alter these parameters as compared with the values during intrinsic conduction. At 16 weeks, acute intrasubject comparison showed that single-site LV apical and LV septal pacing generally resulted in similar or better contractility, relaxation, and efficiency as compared with acute biventricular pacing. Conclusions-Acute and chronic LV apical and LV septal pacing maintain regional cardiac mechanics, contractility, relaxation, and efficiency near native levels, whereas RV apical or RV septal pacing diminish these variables. Acute LV apical and LV septal pacing tend to maintain or improve contractility and efficiency compared with biventricular pacing. (Circ Arrhythmia Electrophysiol. 2009;2:571-579.)Key Words: pacing Ⅲ hemodynamics Ⅲ mapping Ⅲ mechanics Ⅲ oxygen C ompared with normal ventricular activation, conventional right ventricular (RV) apex pacing is associated with asynchronous left ventricular (LV) activation, abnormal contraction, and reduced pump function (for review, see reference 1). 1 These adverse effects have been associated with an increased risk of developing heart failure (for review, see reference 1). 1 Also contributing to this adverse outcome is a reduction in myocardial efficiency during ventricular pacing, which increases total myocardial oxygen demand. Consequently, paced hearts can be expected to be more susceptible to ischemia when coronary reserve is limited, 2 as during coronary artery disease and/or overload of the heart. Clinical Perspective on p 579Several studies have sought alternative pacing sites to improve hemodynamic performance. Because pacing leads are usually implanted transvenously, alternate sites within the RV have been studied most intensively, but results of the various studies are mixed. 3,4 Experimental and clinical studies indicate that LV pacing sites often render better hemodynamic performance than RV pacing sites. [5][6][7] In a previous acute canine stu...

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