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Updated: Jun 20, 2026

Ablation of Ischemic Ventricular Tachycardia Using a Multipolar Catheter and 3-dimensional Mapping System for High-density Electro-anatomical Reconstruction
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Published on: January 31, 2019

Selective site right ventricular pacing.

K Albouaini1, A Alkarmi, T Mudawi

  • 1Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool L14 3PE, UK. Albouaini@aol.com

Heart (British Cardiac Society)
|September 11, 2009
PubMed
Summary
This summary is machine-generated.

Right ventricular apex (RVA) pacing, long standard for pacemakers, can negatively impact heart function. Exploring alternative pacing sites, like the right ventricular outflow tract, may offer better outcomes for patients.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Device Technology

Background:

  • The right ventricular apex (RVA) has been the standard site for transvenous pacemaker lead implantation since 1959 due to ease of access and reliable parameters.
  • However, RVA pacing is known to cause abnormal ventricular conduction and contraction, potentially leading to adverse effects.
  • The development of active fixation leads has enabled exploration of alternative pacing sites.

Purpose of the Study:

  • To review the detrimental effects associated with traditional right ventricular apex pacing.
  • To define the right ventricular outflow tract (RVOT) as a potential alternative pacing site.
  • To discuss the evidence supporting selective site pacing in the right ventricle.

Main Methods:

  • Literature review of studies on right ventricular pacing.
  • Analysis of the anatomical and electrophysiological characteristics of the RVA and RVOT.
  • Evaluation of clinical outcomes data comparing RVA pacing with alternative sites.

Main Results:

  • Pacing from the RVA does not replicate normal physiological ventricular activation patterns.
  • Evidence suggests that alternative pacing sites, particularly within the RVOT, may mitigate some of the negative consequences of RVA pacing.
  • Specific benefits and challenges of RVOT pacing are discussed in relation to lead stability and pacing efficacy.

Conclusions:

  • Traditional RVA pacing, while historically convenient, carries significant risks of suboptimal cardiac function.
  • Selective site pacing, focusing on areas like the RVOT, represents a promising strategy to improve patient outcomes.
  • Further research and clinical adoption of alternative pacing sites are warranted to optimize pacemaker therapy.