Septal ventricular pacing in the immature canine heart: A new perspective

Karpawich, Peter P.; Justice, Cheryl D.; Chang, Chung Ho; Gause, Carole Y.; Kuhns, Lawrence R.

doi:10.1016/0002-8703(91)90195-n

Cited by 82 publications

(57 citation statements)

References 19 publications

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“…34,35 In our study, RVS pacing in human patients caused a significant increase in the IVMD compared with AAI pacing, which indicates that the onset of the LV activation is delayed even during RVS pacing. Such an increase in interventricular dyssynchrony may be a result of the initial impulse propagation through a slow muscular conduction region.…”

Section: Discussionmentioning

confidence: 51%

Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Takemoto

Hasebe

Osaka

et al. 2009

Circ J

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ecent clinical studies have demonstrated that longterm right ventricular apical (RVA) pacing imposes a risk of heart failure, ventricular arrhythmias, and cardiac death. 1-5 RVA pacing causes left ventricular (LV) mechanical dyssynchrony because of altered ventricular excitation that bypasses the His-Purkinje system. 6-9 Longterm RVA pacing results in LV dilatation associated with asymmetric LV hypertrophy, 10,11 regional myocardial perfusion defects 12-14 and a decrease in the LV ejection fraction (LVEF). 12,15,16 Pacing on the right ventricular (RV) septum, RV outflow tract and His or para-His bundle has been introduced as a potentially favorable alternative to RVA pacing to preserve a more physiologic ventricular activation. 8 However, previous investigations of alternative pacing sites have yielded inconsistent results, 17-23 which may be attributable, in part, to the fact that the pacing site was determined on a topological rather than functional basis. 24 Indeed, acute hemodynamic studies have demonstrated that individual optimization of the RV pacing sites could preserve LV performance in patients without LV dysfunction, and that there are substantial individual variations in the optimal pacing sites. 25,26 The paced QRS duration seems to be a practical indicator for determining the optimal RV pacing site. 14,19,22,23 However, information on the most appropriate pacing site to preserve long-term LV function is still limited.To address this issue, we investigated the effect of RV septal (RVS) pacing guided by QRS morphology on longterm LV mechanical synchronicity and function in patients with normal QRS duration and preserved LV function at baseline. Methods PatientsWe retrospectively studied 55 patients (22 men, 32 women; 70±10 years) undergoing dual-chamber pacemaker implantation for advanced atrioventricular block (AVB; n=33) or sinus node dysfunction (SND, n=22). In 40 patients (n=24 for AVB, n=16 for SND), pace mapping was carried out at the junction between the upper and middle segments of the RV septum using a hand-shaped stylet under fluoroscopy

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Section: Discussionmentioning

confidence: 51%

Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Takemoto

Hasebe

Osaka

et al. 2009

Circ J

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“…Mera and colleagues [44] showed that shorter paced QRS duration correlated with improved ejection fraction, and this has been confirmed in other studies, both in humans [37] and in animal models [55,56]. Intuitively, it would seem appropriate to aim for the shortest paced QRS duration possible, as this would decrease total ventricular activation time, potentially leading to a more synchronous ventricular activation pattern, which may be beneficial in the long term.…”

Section: Chronic Right Ventricular Outflow Tract Pacing Studiesmentioning

confidence: 81%

Selective site ventricular pacing

McGavigan

Mond

2006

Current Opinion in Cardiology

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“…In addition, there is a significant echocardiographic improvement followed by clinical benefit that is usually reflected bythe reduction of the quality of life score.. These findings are strengthened by the experimental study of Karpawich et al [20] who obtained great histological benefit from septal pacing in relation to apical pacing. They showed a very significant and udesirable histological remodeling by RV apical pacing that was prevented by the RV septal pacing (Figure 3).…”

Section: Discussionmentioning

confidence: 92%

“…These findings suggest that the electrical axis is more physiological when the QRS results from the septal in relation to the apical pacing. Hence, considering the electrical axis of the paced QRS, the septal pacing should be preferred in relation to the classical pacing, since the physiological progression of the myocardial activation reduces the histological remodeling of the wall of the LV [20], besides improving its hemodynamic performance [24].…”

Section: Qrs Axismentioning

confidence: 99%

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

Mateos¹,

Mateos²,

Vargas³

et al. 2012

Rev Bras Cir Cardiovasc

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Comparação de parâmetros eletrofisiológicos das estimulações cardíacas endocárdicas septal e apicalComparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation Abstract Background: The conventional right ventricle (RV) endocardial pacing leads QRS widening and myocardial desynchronization compromising ventricular function. With the need for less deleterious stimulation, RV septal pacing has been used more. Eventually have been reported higher thresholds and smaller R waves in the septal stimulation.Objective: To compare the parameters of the septal and apical stimulation, intra-patient, if there are any differences that may affect the choice of the point of stimulation.Methods: A prospective controlled study. We included 25 patients, 67.2±9 years, 10 (40%) women with indications for pacemaker for bradyarrhythmias. Etiologies were degenerative in nine (36%), Coronary disease in eight (32%), Chagas disease in seven (28%), and valve disease in one (4%) patient. Electrodes were active fixation and assessed the thresholds of command, impedance and R wave in uniand bipolar implant and after six months. Rev Bras Cir Cardiovasc 2012;27(2):195-202 Results

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Septal ventricular pacing in the immature canine heart: A new perspective

Cited by 82 publications

References 19 publications

Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Right Ventricular Septal Pacing Preserves Long-Term Left Ventricular Function Via Minimizing Pacing-Induced Left Ventricular Dyssynchrony in Patients With Normal Baseline QRS Duration

Selective site ventricular pacing

Comparison of electrophysiological parameters of septal and apical endocardial cardiac stimulation

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