The Downside of Right Ventricular Apical Pacing

Brenyo, Andrew; Goldenberg, Ilan; Barsheshet, Alon

doi:10.1016/s0972-6292(16)30502-2

Cited by 21 publications

(15 citation statements)

References 59 publications

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“…The difference in backup rate between the two groups resulted in a significant difference in the burden of RV pacing (60% vs. 3%). A right-ventricular pacing dose-dependent positive relationship with adverse cardiovascular events was well noted, in keeping with the findings from the MOST trial [ 32 ]. A systematic review and meta-analysis by Hussain et al .…”

Section: Rva Pacing Outcomes From Conducted Studiessupporting

confidence: 80%

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

Khurwolah

Yao

Kong

2019

CCR

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Several studies have focused on the deleterious consequences of Right Ventricular Apical (RVA) pacing on Left Ventricular (LV) function, mediated by pacing-induced ventricular dyssynchrony. Therapeutic strategies to reduce the detrimental consequences of RVA pacing have been proposed, that includes upgrading of RVA pacing to Cardiac Resynchronization Therapy (CRT), alternative Right Ventricular (RV) pacing sites, minimal ventricular pacing strategies, as well as atrial-based pacing. In developing countries, single chamber RV pacing still constitutes a majority of cases of permanent pacing, and assessment of the optimal RV pacing site is of paramount importance. In chronically-paced patients, it is crucial to maintain as close and normal LV physiological function as possible, by minimizing ventricular dyssynchrony, reducing the chances for heart failure and other complications to develop. This review provides an analysis of the deleterious immediate and long-term consequences of RVA pacing, and the most recent available evidence regarding improvements in pacing options and strategies to optimize LV diastolic and systolic function. Furthermore, the place of advanced echocardiography in the identification of patients with pacing-induced LV dysfunction, the potential role of a new predictor of LV dysfunction in RV-paced subjects, and the long- term outcomes of patients with RV septal pacing will be explored.

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Section: Rva Pacing Outcomes From Conducted Studiessupporting

confidence: 80%

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

Khurwolah

Yao

Kong

2019

CCR

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“…Native LBBB can cause hemodynamic deterioration due to ventricular dyssynchrony, mainly in patients with heart failure. However, LBBB induced by RV apical pacing seems to lead to worse outcomes when compared to native LBBB, increasing ventricular dyssynchrony [39] , [40] , [41] . The latest LV mechanical activation during RV apical pacing, indeed, is different from that during native LBBB, being more delayed at the baso-lateral LV wall [42] .…”

Section: Ventricular Pacing Effects On the Electrical Mechanical Anmentioning

confidence: 99%

Ventricular pacing – Electromechanical consequences and valvular function

Ebrille

DeSimone

Vaidya

et al. 2016

Indian Pacing and Electrophysiology Journal

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Although great strides have been made in the areas of ventricular pacing, it is still appreciated that dyssynchrony can be malignant, and that appropriately placed pacing leads may ameliorate mechanical dyssynchrony. However, the unknowns at present include:1. The mechanisms by which ventricular pacing itself can induce dyssynchrony;2. Whether or not various pacing locations can decrease the deleterious effects caused by ventricular pacing;3. The impact of novel methods of pacing, such as atrioventricular septal, lead-less, and far-field surface stimulation;4. The utility of ECG and echocardiography in predicting response to therapy and/or development of dyssynchrony in the setting of cardiac resynchronization therapy (CRT) lead placement;5. The impact of ventricular pacing-induced dyssynchrony on valvular function, and how lead position correlates to potential improvement.This review examines the existing literature to put these issues into context, to provide a basis for understanding how electrical, mechanical, and functional aspects of the heart can be distorted with ventricular pacing. We highlight the central role of the mitral valve and its function as it relates to pacing strategies, especially in the setting of CRT. We also provide future directions for improved pacing modalities via alternative pacing sites and speculate over mechanisms on how lead position may affect the critical function of the mitral valve and thus overall efficacy of CRT.

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“…Asynchronous myocardial contraction significantly decreases the stroke volume and right-shifts the LV end-systolic pressure -volume relationship. Thus, RV apical pacing leads to ventricular dyssynchronization, systolic and diastolic ventricular dysfunction, increase of wall stress, and energetic inefficiency [52]. It also causes interventricular dyssynchronization, as the RV contracts earlier than in a physiological model.…”

Section: Ewa Majos Et Al the Right Ventricle In Patients With Chronmentioning

confidence: 99%

The right ventricle in patients with chronic heart failure and atrial fibrillation

Majos

Dąbrowski²,

Szwed³

2013

Cardiol J

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The Downside of Right Ventricular Apical Pacing

Cited by 21 publications

References 59 publications

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

Adverse Consequences of Right Ventricular Apical Pacing and Novel Strategies to Optimize Left Ventricular Systolic and Diastolic Function

Ventricular pacing – Electromechanical consequences and valvular function

The right ventricle in patients with chronic heart failure and atrial fibrillation

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