Alternative Right Ventricular Pacing Sites

Abstract

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. Objectives. The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing. Material and 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 (Adv Clin Exp Med 2015, 24, 2, 349-359).

Inappropriate shock and percutaneous cardiac intervention: A lesson to learn in the cath lab

“…The ventricular lead was fixed by screwing it into the right mid‐anterior septum, in line with the current literature, to avoid dyssynchrony by ventricular stimulation in case of future advanced atrioventricular block . The lead helix tip was placed in proximity of the LAD course, apparently outside the lumen during contrast injection (Figure ).…”

“…There has been an increasing interest in the implantation of right ventricular leads in the right ventricular septum or right ventricular outflow tract as a means to produce a more physiological contraction and narrower QRS . Unfortunately, based on conventional fluoroscopic criteria, lead implantation at the septum level is sometime fixed in the anteroseptal junction, with a higher risk of interventricular artery perforation …”

“…The ventricular lead was fixed by screwing it into the right mid-anterior septum, in line with the current literature, to avoid dyssynchrony by ventricular stimulation in case of future advanced atrioventricular block. 6 The lead helix tip was placed in proximity of the LAD course, apparently outside the lumen during contrast injection ( Figure 1). Nevertheless, the presence of clear noise on the ventricular bipolar recording -not visualized on the atrial lead-was followed by an inappropriate shock delivered without arrhythmia detection on the monitor by the cardiology team ( Figure 2).…”

“…Right ventricular pacing leads can be implanted in the septum or right ventricular outflow tract to reduce the incidence of perforation and potentially provide a narrower paced QRS . The close relationship between the right ventricle and the coronary anatomy is crucial during lead implantation to avoid vessel perforation and subsequent infarction.…”

“…[3][4][5] Right ventricular pacing leads can be implanted in the septum or right ventricular outflow tract to reduce the incidence of perforation and potentially provide a narrower paced QRS. 6 The close relationship between the right ventricle and the coronary anatomy is crucial during lead implantation to avoid vessel perforation and subsequent infarction. Consideration of this point is even more important during percutaneous coronary intervention (PCI) in patients with a cardiac implantable electronic device (CIED) in daily practice.…”