Long-term right ventricular pacing leads to ventricular dyssynchrony and adverse outcomes, which may be mitigated by biventricular pacing or specific pacemaker algorithms.
Do strategies that avoid unnecessary right ventricular pacing prevent adverse clinical outcomes in patients with symptomatic bradycardia?
Avoiding unnecessary right ventricular pacing, particularly in patients with reduced LVEF, using CRT or specific algorithms may prevent ventricular dyssynchrony and subsequent adverse clinical outcomes.
Symptomatic bradycardia is effectively treated with the implantation of a cardiac pacemaker. Although a highly successful therapy, during recent years there has been a focus on the negative effects associated with long-term pacing of the apex of the right ventricle (RV). It has been shown in both experimental and clinical studies that RV pacing leads to ventricular dyssynchrony, similar to that of left bundle branch block, with subsequent detrimental effects on cardiac structure and function, and in some cases adverse clinical outcomes such as atrial fibrillation, heart failure and death. There is substantial evidence that patients with reduced left ventricular function (LVEF) are at particular high risk of suffering the detrimental clinical effects of long-term RV pacing. The evidence is, however, incomplete, coming largely from subanalyses of pacemaker and implantable cardiac defibrillator studies. In this group of patients with reduced LVEF and an expected high amount of RV pacing, biventricular pacing (cardiac resynchronization therapy) devices can prevent the negative effects of RV pacing and reduce ventricular dyssynchrony. Therefore, cardiac resynchronization therapy has emerged as an attractive option with promising results and more clinical studies are underway. Furthermore, specific pacemaker algorithms, which minimize RV pacing, can also reduce the negative effects of RV stimulation on cardiac function and may prevent clinical deterioration.
Finn Åkerström (Tue,) conducted a review in Symptomatic bradycardia. Biventricular pacing and RV pacing minimization algorithms vs. Long-term right ventricular apical pacing was evaluated. Long-term right ventricular pacing leads to ventricular dyssynchrony and adverse outcomes, which may be mitigated by biventricular pacing or specific pacemaker algorithms.