Key result
Alternative pacing modalities and sites, including His bundle and biventricular pacing, are being explored to reduce the adverse effects of chronic right ventricular apical pacing.
This review highlights the detrimental effects of chronic RV apical pacing and discusses emerging alternative pacing sites and modalities, such as His bundle pacing and biventricular pacing, to preserve ventricular function.
Supports exploring alternatives to RV apical pacing; leaves open optimal site selection pending randomized trials.
Right ventricular (RV) apical pacing impairs left ventricular function by inducing dys-synchronous contraction and relaxation. Chronic RV apical pacing is associated with an increased risk of atrial fibrillation, morbidity, and even mortality. These observations have raised questions regarding the appropriate pacing mode and site, leading to the introduction of algorithms and new pacing modes to reduce the ventricular pacing burden in dual chamber devices, and a shift of the pacing site away from the RV apex. However, further investigations are required to assess the long-term results of pacing from alternative sites in the right ventricle, because long-term results so far are equivocal. The potential benefit of prophylactic biventricular, mono-chamber left ventricular, and bifocal RV pacing should be explored in selected patients with a narrow QRS complex, especially those with impaired left ventricular function. His bundle pacing is a promising and evolving technique that requires improvements in lead technology.
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Padeletti et al. (2006) conducted a review in Pacing-induced dys-synchrony. Physiologic pacing (alternative pacing sites, His bundle pacing) vs. Right ventricular apical pacing was evaluated. Alternative pacing modalities and sites, including His bundle and biventricular pacing, are being explored to reduce the adverse effects of chronic right ventricular apical pacing.
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