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Chronic Right Ventricular Pacing in the Heart Failure Population
Justin Gould1,2, Benjamin Sieniewicz3,4, Bradley Porter3,4
1King's College London, London, UK. justin.s.gould@kcl.ac.uk.
Current Heart Failure Reports
|February 14, 2018
Summary
Right ventricular apical pacing may harm patients with heart failure and AV block. Cardiac resynchronization therapy (CRT) shows benefits for some, but its effectiveness in mild heart failure requires further study.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Right ventricular (RV) apical pacing is a common treatment for atrioventricular (AV) block.
- Concerns exist regarding potentially harmful effects of RV apical pacing.
- Cardiac resynchronization therapy (CRT) is an alternative for heart failure patients.
Purpose of the Study:
- To review trials on harmful effects of RV apical pacing.
- To evaluate alternative RV pacing sites.
- To assess CRT's role in heart failure with AV block.
Main Methods:
- Review of clinical trials and existing evidence.
- Analysis of outcomes comparing CRT and RV pacing.
- Focus on patients with heart failure and AV block.
Main Results:
- CRT may improve left ventricular function and reverse remodeling in moderate-to-severe heart failure with AV block compared to RV pacing.
- The BLOCK HF trial showed better outcomes with CRT but no mortality benefit in specific patient groups.
- CRT benefits in mild left ventricular dysfunction with AV block are less clear.
Conclusions:
- CRT is a viable option for select heart failure patients with AV block and impaired left ventricular function.
- RV apical pacing may have detrimental effects.
- Further research is needed to clarify CRT's role in milder forms of left ventricular dysfunction.
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