Key result
Pacing from the right ventricular apex produces abnormal late activation of the lateral wall of the left ventricle, leading to ventricular remodelling.
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Discusses the physiological consequences of right ventricular apical pacing and the potential need for alternative pacing sites such as the right ventricular outflow tract septum.
Since the introduction of transvenous cardiac pacing almost 50 years ago,1 the right ventricular (RV) apex has been the preferred site for ventricular lead attachment due to the ease of placement, stability, reliability and lead design. Unfortunately, pacing from the RV apex produces an abnormal late activation of the lateral wall of the left ventricle (LV),2 with ventricular remodelling resuling from neurohormonal and electrophysiological changes.
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Hillock et al. (2007) conducted an editorial in Cardiac pacing. Right Ventricular Outflow Tract Septum pacing vs. Right ventricular apex pacing was evaluated. Pacing from the right ventricular apex produces abnormal late activation of the lateral wall of the left ventricle, leading to ventricular remodelling.
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