The Deleterious Consequences of Right Ventricular Apical Pacing: Time to Seek Alternate Site Pacing

Manolis, Antonis S.

doi:10.1111/j.1540-8159.2006.00338.x

Cited by 144 publications

(113 citation statements)

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“…The SPWMD was significantly larger in the RVP (338 ± 20 ms) than in the LVP (-16 ± 14 ms) or control (-5 ± 35 ms) group, whereas QRS duration was similarly longer in the RVP (157 ± 10 ms) and LVP (158 ± 22 ms) groups compared than in the control group (69 ± 7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.Keywords Cardiac function Á Children Á Dyssynchrony Á Pacing Á Site Á Ventricular In children and adults with congenital or acquired atrioventricular (AV) block, the ventricular pacing lead is traditionally positioned at the right ventricle (RV) [16,19]. However, RV apex pacing causes an acute decrease in left ventricular (LV) function in animals [26], adults [6] and children [14,36].…”

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confidence: 99%

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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Chronic right ventricular (RV) pacing can induce structural and functional cardiac deterioration. Because animal studies showed a benefit of left ventricular (LV) over RV pacing, this study compared the effects of chronic RV and LV pacing in children. Retrospectively, echocardiographic data were evaluated from 18 healthy children (control subjects) and from children undergoing chronic epicardial RV pacing (7 RVP) or LV pacing (7 LVP). Assessment included LV end-diastolic wall thickness (LVEDWT) and end-systolic wall thickness (LVESWT) as well as LV end-diastolic diameter (LVEDD) and end-systolic diameter (LVESD). The shortening fraction and eccentricity index (LV diameter/2 9 LV wall thickness) were calculated as measures of LV function and eccentricity, respectively. Duration of QRS and septal posterior wall motion delay (SPWMD) were used as measures of electrical and mechanical dyssynchrony, respectively. A p value less than 0.05 determined significance. As the findings showed, LVEDD, LVESD, LVEDWT, and LVESWT were not significantly different between the groups. The shortening fraction was significantly lower in the RVP (21.7% ± 6.0%) than in the LVP (32.2% ± 5.2%) or control (29.3% ± 4.3%) children. The systolic LV eccentricity index was significantly larger in the RVP (1.8 ± 0.2) than in the LVP (1.4 ± 0.1) or control (1.4 ± 0.2) children. The SPWMD was significantly larger in the RVP (338 ± 20 ms) than in the LVP (-16 ± 14 ms) or control (-5 ± 35 ms) group, whereas QRS duration was similarly longer in the RVP (157 ± 10 ms) and LVP (158 ± 22 ms) groups compared than in the control group (69 ± 7 ms). The authors conclude that LV function in children is preserved by chronic pacing at the LV lateral wall.Keywords Cardiac function Á Children Á Dyssynchrony Á Pacing Á Site Á Ventricular In children and adults with congenital or acquired atrioventricular (AV) block, the ventricular pacing lead is traditionally positioned at the right ventricle (RV) [16,19]. However, RV apex pacing causes an acute decrease in left ventricular (LV) function in animals [26], adults [6] and children [14,36]. During chronic RV pacing in children, LV function, morphology [30,31], and histology [15] are at risk for deterioration over time (for review see Karpawich [16]). Chronic RV pacing can eventually result in cardiac failure, which occurs in 6% to 7% of children [17,20,38]. Also, in adults, chronic RV apex pacing has deleterious effects (for review see Manolis [19]) and increases the risk of heart failure [1,28].Recognition of the possible harmful effects from RV apex pacing initiated the search for alternative ventricular pacing sites including the RV outflow tract, His bundle, LV wall, and biventricular pacing. Pacing at the His bundle is likely the superior approach [8], but appears to be

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Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

et al. 2008

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“…The region of the bundle of His (para-His), the right ventricle outflow tract (RVOT) and the septal region (septal) have all been evaluated 28,29 . In Brazil, Jatene and Korman 30 described a technique of implantation in the region of the RV inflow tract as an alternate site in Chagas disease, due to the cardiac structural changes observed at the RV apex in these patients.…”

Section: Methodsmentioning

confidence: 99%

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

Júnior

Maeda

Borges

et al. 2012

Rev. Soc. Bras. Med. Trop.

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Introduction: The septal position is an alternative site for cardiac pacing (CP) that is potentially less harmful to cardiac function. Methods: Patients with Chagas disease without heart failure submitted to permanent pacemaker (PP) implantation at the Clinics Hospital of the Triângulo Mineiro Federal University (UFTM), were selected from February 2009 to February 2010. The parameters analyzed were ventricular remodeling, the degree of electromechanical dyssynchrony (DEM), exercise time and VO2 max during exercise testing (ET) and functional class (NYHA). Echocardiography was performed 24 to 48h following implantation and after one year follow-up. The patients were submitted to ET one month postprocedure and at the end of one year. Results: Thirty patients were included. Patient mean age was 59±13 yearsold. Indication for PP implantation was complete atrioventricular (AV) block in 22 (73.3%) patients and 2 nd degree AV block in the other eight (26.7%). All patients were in NYHA I and no changes occurred in the ET parameters. No variations were detected in echocardiographic remodeling measurements. Intraventricular dyssynchrony was observed in 46.6% of cases and interventricular dyssynchrony in 33.3% of patients after one year. Conclusions: The findings of this work suggest that there is not significant morphological and functional cardiac change following pacemaker implantation in septal position in chagasic patients with normal left ventricular function after one year follow-up. Thus, patients may remain asymptomatic, presenting maintenance of functional capacity and no left ventricular remodeling.

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“…The most common adverse effects of chronic RVA pacing are: iatrogenically accentuated intraventricular conduction delay, left ventricular electrical and mechanical dyssynchrony, left ventricular remodeling, abnormalities in myocardial histopathology, left ventricular dysfunction (both systolic and diastolic), congestive heart failure, myocardial perfusion defects and regional wall motion abnormalities, functional mitral regurgitation, increased risk of atrial fibrillation (in patients with sinus node dysfunction and normal baseline QRS duration), left atrial enlargement, promotion of ventricular arrhythmias, activation of sympathetic nervous system [4].…”

Section: Adverse Effects Of Rva Pacingmentioning

confidence: 99%

Alternative Right Ventricular Pacing Sites

Łuciuk¹,

Łuciuk²,

Gajek³

2015

Adv Clin Exp Med

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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).

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The Deleterious Consequences of Right Ventricular Apical Pacing: Time to Seek Alternate Site Pacing

Cited by 144 publications

References 118 publications

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

Chronic Left Ventricular Pacing Preserves Left Ventricular Function in Children

One-year cardiac morphological and functional evolution following permanent pacemaker implantation in right ventricular septal position in chagasic patients

Alternative Right Ventricular Pacing Sites

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