Key result
Pharmacological agents such as ACE inhibitors, ARBs, and beta blockers may prevent pacing-induced left ventricular remodeling by targeting the extracellular matrix in patients with obligatory right ventricular pacing.
Why the study?
Do angiotensin converting enzyme inhibitors, angiotensin receptor blockers, or beta blockers prevent pacing-induced left ventricle remodeling in patients with implanted pacemakers and obligatory right ventricle pacing?
Do angiotensin converting enzyme inhibitors, angiotensin receptor blockers, or beta blockers prevent pacing-induced left ventricle remodeling in patients with implanted pacemakers and obligatory right ventricle pacing?
Pharmacological agents like ACE inhibitors, ARBs, and beta blockers may have a role in preventing pacing-induced left ventricular remodeling in patients requiring obligatory right ventricular pacing.
Should not yet change practice in RV-paced patients; hypothesis-generating for matrix-targeted therapies and requires randomized validation.
Right ventricle apical pacing causes dyssynchronous left ventricle contraction. Dyssynchrony leads to ventricular remodeling and an overt heart failure eventually. Experimental animal studies lend the evidence that dyssynchronous contraction is accompanied by tremendous derangement in extracellular compartment with altered collagen content, activity and expression of matrix metalloproteinases and their inhibitors. The capability of some therapeutic agents like angiotensin converting enzyme inhibitors, angiotensin receptor blockers or beta blockers to prevent postinfarction left ventricle remodeling should be considered as an anti-remodeling treatment in patients with implanted pacemakers and obligatory right ventricle pacing. We summarize the evidence and rationale for such preventive management.
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Andrzej Tomasik (2015) conducted a review in Pacing-induced heart remodeling. Pharmacological prevention (ACE inhibitors, ARBs, beta blockers) was evaluated. Pharmacological agents such as ACE inhibitors, ARBs, and beta blockers may prevent pacing-induced left ventricular remodeling by targeting the extracellular matrix in patients with obligatory right ventricular pacing.
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