The quest for physiological pacing—Does one size fit all?

Abstract

Pacing is an established and ubiquitous treatment of bradycardias and some types of heart failure. The optimal pacing lead position which maximizes cardiac function and minimizes deterioration of ventricular function remains controversial. The desire to achieve a physiological pacing system that mimics cardiac function has led to the investigation of several potential pacing sites. This editorial provides an overview of past and current pacing lead position and summaries the current and future direction of physiological pacing.

The effect of dyssynchrony on hemodynamics after pacemaker implantation

“…Some patients develop impaired Left Ventricular (LV) contraction due to dyssynchrony after Permanent Pacemaker Implantation (PMI), i.e., Pacemaker-Induced Cardiomyopathy (PICM), which may cause symptomatic heart failure. Although proper Right Ventricular (RV) pacing position may prevent PICM, there are no well-established methods for achieving this [1]. It is feasible to analyze the correlation between LV contraction and pacing position via longitudinal strain on 2-dimensional speckle-tracking echocardiography.…”

Chronic effects of right ventricular pacing: The impact of right ventricular lead position

“…However, due to compiling data on the negative consequences of RV apical pacing, the search for the optimal pacing site emerged. [81][82][83][84][85][86][87] It was hypothesised that RV leads positioned in close proximity to the conduction system would result in a more physiological activation and thus had the potential to mitigate the negative effects induced by pacing. [87][88][89] These alternative sites have included the RV outflow tract, the RV septum, the RV inflow tract and more recently, conduction system pacing has received much attention.…”