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The downside of right ventricular apical pacing
Andrew Brenyo1, Ilan Goldenberg, Alon Barsheshet
1Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY.
Indian Pacing and Electrophysiology Journal
|June 6, 2012
Summary
Chronic right ventricular apical pacing, once standard, is now linked to increased heart failure and death. This review examines the adverse effects, focusing on pacing-induced ventricular dyssynchrony and its impact based on QRS duration.
Area of Science:
- Cardiology
- Biomedical Engineering
- Electrophysiology
Background:
- The right ventricular (RV) apex has been the conventional site for pacemaker lead implantation since the inception of cardiac pacing technology.
- Initially indicated for severe bradyarrhythmias, RV pacing is now employed for a broader range of cardiac conditions.
- Emerging evidence highlights potential adverse effects associated with chronic RV apical pacing.
Purpose of the Study:
- To review the detrimental effects of chronic RV apical pacing.
- To elucidate the hemodynamic pathophysiology underlying these adverse effects.
- To emphasize the role of RV pacing-induced ventricular dyssynchrony and its correlation with QRS morphology.
Main Methods:
- Literature review of studies investigating RV apical pacing.
- Analysis of hemodynamic principles related to ventricular pacing.
- Examination of data correlating QRS morphology with patient outcomes.
Main Results:
- Chronic RV apical pacing is associated with an increased risk of heart failure and mortality.
- Ventricular dyssynchrony induced by RV apical pacing contributes significantly to adverse outcomes.
- Differential patient outcomes are observed based on baseline QRS duration and morphology.
Conclusions:
- RV apical pacing, despite its widespread use, carries significant risks.
- Understanding the mechanisms of RV pacing-induced dyssynchrony is crucial for mitigating adverse effects.
- Patient selection and lead placement strategies may need re-evaluation to optimize long-term outcomes.
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