Key result
Stimulation from the right ventricle apex (RVA) significantly increases the risk of heart failure compared to stimulation from the right ventricular outflow tract (RVOT).
Why the study?
It was unclear whether pacemaker stimulation from the apex or right ventricle outflow tract has deleterious effects on left ventricle function.
Does permanent pacemaker stimulation from the right ventricle outflow tract compared to the right ventricle apex improve left ventricle function and prevent heart failure in patients with conduction tissue diseases?
Does permanent pacemaker stimulation from the right ventricle outflow tract compared to the right ventricle apex improve left ventricle function and prevent heart failure in patients with conduction tissue diseases?
Right ventricular outflow tract pacing may be preferable to right ventricular apical pacing to prevent pacing-induced dyssynchrony and heart failure, particularly in patients with reduced ejection fraction.
Conduction tissue diseases of the heart, which are characterized by slowing of the heart rate are treated by pacemaker stimulation from right atrium and right ventricle. However, there is a rising question whether this kind of stimulation, either from the apex of the right ventricle outflow tract can have a deleterious effect on left ventricle function. Analyzing this effect of permanent pacemaker stimulation on left ventricle function we measured QRS duration according to ventricle lead position in right ventricle. This stimulation is without alternative in all the conduction tissue diseases which are characterized by chronotropic incompetence and bradycardia. The stimulation from right ventricle apex gives arise to inter and intraventricular dissinchrony and thus creates greater risk of heart failure developmen. Right ventricle outflow tract position of the pace maker electrode represents simple and if not better, than at least not worse solution in heart failure prevention due to pacemaker stimulation, especially in patients with already reduced ejection fraction.
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Mitov et al. (2019) studied heart failure (n=3,000). antibradycardial pacemaker stimulation vs. control group with QRS duration less than 160 ms was evaluated on incidence of heart failure based on QRS duration (HR null, 95% CI null, p=null). Stimulation from the right ventricle apex (RVA) significantly increases the risk of heart failure compared to stimulation from the right ventricular outflow tract (RVOT).
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