Conventional right ventricular apical pacing may have detrimental effects on cardiac structure and left ventricular function, which may be mitigated by cardiac resynchronization therapy.
Does right ventricular apical pacing cause detrimental effects on ventricular function and dyssynchrony in patients requiring cardiac pacing?
This review highlights the potential detrimental effects of right ventricular apical pacing on left ventricular function and discusses alternatives such as cardiac resynchronization therapy.
Cardiac pacing is the only effective treatment for patients with sick sinus syndrome and atrioventricular conduction disorders. In cardiac pacing, the endocardial pacing lead is typically positioned at the right ventricular (RV) apex. At the same time, there is increasing indirect evidence, derived from large pacing mode selection trials and observational studies, that conventional RV apical pacing may have detrimental effects on cardiac structure and left ventricular function, which are associated with the development of heart failure. These detrimental effects may be related to the abnormal electrical and mechanical activation pattern of the ventricles (or ventricular dyssynchrony) caused by RV apical pacing. Still, it remains uncertain if the deterioration of left ventricular function as noted in a proportion of patients receiving RV apical pacing is directly related to acutely induced left ventricular dyssynchrony. The upgrade from RV pacing to cardiac resynchronization therapy may partially reverse the deleterious effects of RV pacing. It has even been suggested that selected patients with a conventional pacemaker indication should receive cardiac resynchronization therapy to avoid the deleterious effects. This review will provide a contemporary overview of the available evidence on the detrimental effects of RV apical pacing. Furthermore, the available alternatives for patients with a standard pacemaker indication will be discussed. In particular, the role of cardiac resynchronization therapy and alternative RV pacing sites in these patients will be reviewed.
Tops et al. (Sat,) conducted a review in Sick sinus syndrome and atrioventricular conduction disorders. Right ventricular apical pacing vs. Cardiac resynchronization therapy and alternative RV pacing sites was evaluated. Conventional right ventricular apical pacing may have detrimental effects on cardiac structure and left ventricular function, which may be mitigated by cardiac resynchronization therapy.
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