Selective Site Pacing:

Abstract

Animal data and recent findings in humans have questioned the appropriateness of pacing the heart from the right ventricular apex. Numerous, mostly small sized, studies have evaluated alternative sites within the right ventricle. There is now sufficient evidence that right ventricular apical pacing in patients with left ventricular dysfunction with or without heart failure is detrimental. Pacing from the right side of the heart as an attempt at nonpharmacological therapy for heart failure, turns out to be obsolete. In antibradycardia pacing with the need for continuous ventricular support, the interest in preserving left ventricular function drives the ongoing search for the most favorable pacing site within the right ventricle. Results, so far, are conflicting which may be attributed to the inhomogeneity of patient groups, the small cohorts studied, the differing protocols used, and the lack of accepted definitions of right ventricular lead positions. Larger studies are needed to evaluate intraoperative criteria for optimal lead placement and the potential benefit of nonapical right ventricular pacing.

Cardiac Resynchronization Therapy Using a VDD Lead

“…In patients with major right chamber dilatation, a 13 cm distance between the atrial and ventricular poles may prove insufficient 5 . Lastly, right chamber pacing can only be delivered at the ventricular apex with this tined lead and not at the septum as it is now recommended 6 …”

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation

“…In an attempt to optimize cardiac function, RV leads are no longer simply placed in the RV apex but are being positioned along the intraventricular septum and outflow tract. 209 The atrial leads are no longer simply placed in the high RA or atrial appendage but are now being positioned in one or more sites in the RA and sometimes LA in an attempt to suppress atrial fibrillation. 208 These concepts have resulted in the term "selective site pacing" as the preferred means of cardiac stimulation in any given patient.…”

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation in Adults

“…This is because the RV apex is readily available, reliable, and proved to be stable over time. 181 The atrial leads are no longer simply placed in the high RA or atrial appendage but are now being positioned in one or more sites in the right atrium and sometimes the left atrium in an attempt to suppress AF. More recently, the conventional sites for placement of RA and ventricular leads have been challenged as inadequate and nonphysiologic.…”