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Focus on right ventricular outflow tract septal pacing

Antoine Da Costa1, Laurent Gabriel, Cécile Romeyer-Bouchard

  • 1Service de Cardiologie, Université Jean Monnet, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, France. dakosta@aol.com

Archives of Cardiovascular Diseases
|July 16, 2013
PubMed

Insights

Right ventricular apical pacing can harm left ventricular function over time. Alternative septal pacing methods show limited benefits, but ongoing studies aim to clarify their long-term efficacy and patient outcomes.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Cardiac Pacing

Background:

  • Right ventricular apical pacing (RVAP) is linked to adverse left ventricular (LV) remodeling and desynchronization.
  • This risk is elevated in patients with moderate LV dysfunction, manifesting after prolonged pacing.
  • RVAP can contribute to organic mitral insufficiency, prompting research into alternative pacing sites.

Purpose of the Study:

  • To evaluate the long-term effects of RVAP on LV remodeling and function.
  • To compare the clinical outcomes of RVAP with alternative pacing strategies like right ventricular outflow tract (RVOT) septal pacing.
  • To identify potential benefits of infundibular septal pacing over RVAP.

Main Methods:

  • Review of experimental and clinical studies on RVAP and alternative pacing.
  • Analysis of prospective randomized studies and meta-analyses comparing RVAP and RVOT septal pacing.
  • Consideration of ongoing multicenter randomized trials assessing infundibular septal pacing.

Main Results:

  • RVAP can lead to significant LV desynchronization and remodeling, particularly after one year.
  • Current studies show modest medium-term effects of RVOT septal pacing on ejection fraction, with no significant impact on quality of life or survival.
  • Previous comparative studies may lack sufficient statistical power and homogeneity.

Conclusions:

  • RVAP poses long-term risks to LV function and remodeling.
  • Current evidence for RVOT septal pacing offers limited clinical advantages over RVAP.
  • Further robust research, including ongoing trials, is necessary to definitively assess infundibular septal pacing's efficacy and patient prognosis.

Keywords:
AFApical pacingCRTDDDDefibrillatorDéfibrillateurEFHRInfundibular pacingLVLVEFPacemakerRVRVAPRVOTSeptal pacingStimulation apicaleStimulation infundibulaireStimulation septaleVVIatrial fibrillationcardiac resynchronization therapydual-chamber pacemakersejection fractionhazard ratioleft ventricleleft ventricular ejection fractionright ventricleright ventricular apical pacingright ventricular outflow tractsingle-chamber ventricular pacing

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