Advances in Clinical and Experimental Medicine
2015, vol. 24, nr 2, March-April, p. 349–359
doi: 10.17219/acem/27568
Publication type: review
Language: English
Download citation:
Alternative Right Ventricular Pacing Sites
1 Department of Cardiology, Wroclaw Medical University, Poland
2 Department of Otolaryngology, Head and Neck Surgery, Wroclaw Medical University, Poland
Abstract
Background. The main adverse effect of chronic stimulation is stimulation-induced heart failure in case of ventricular contraction dyssynchrony. Because of this fact, new techniques of stimulation should be considered to optimize electrotherapy. One of these methods is pacing from alternative right ventricular sites.
Objectives. The purpose of this article is to review currently accumulated data about alternative sites of cardiac pacing.
Material and Methods. Medline and PubMed bases were used to search English and Polish reports published recently.
Results. Recent studies report a deleterious effect of long term apical pacing. It is suggested that permanent apical stimulation, by omitting physiological conduction pattern with His-Purkinie network, may lead to electrical and mechanical dyssynchrony of heart muscle contraction. In the long term this pathological situation can lead to severe heart failure and death. Because of this, scientists began to search for some alternative sites of cardiac pacing to reduce the deleterious effect of stimulation. Based on current accumulated data, it is suggested that the right ventricular outflow tract, right ventricular septum, direct His-bundle or biventricular pacing are better alternatives due to more physiological electrical impulse propagation within the heart and the reduction of the dyssynchrony effect. These methods should preserve a better left ventricular function and prevent the development of heart failure in permanent paced patients. As there is still not enough, long-term, randomized, prospective, cross-over and multicenter studies, further research is required to validate the benefits of using this kind of therapy.
Conclusion. The article should pay attention to new sites of cardiac stimulation as a better and safer method of treatment.
Key words
artificial pacemaker, cardiac pacing, artificial, tricuspid valve insufficiency, heart failure, myocardial contraction.
References (43)
- Birnie D, Williams K, Guo A, Mielniczuk L, Davis D, Lemery R, Green M, Gollob M, Tang A: Reasons for escalating pacemaker implants. Am J Cardiol 2006, 1, 98, 93–97. Epub 2006 May 6.
- Brinker J, Midei MG: Techniques of Pacemaker Implantation and Removal, in Cardiac Pacing and ICDs. eds.: KA Ellenbogen, MA Wood, Blackwell Publishing 2007, Inc, Malden, Massachusetts, USA. DOI:10.1002/ /9780470750674.ch5.
- Burns KV, Gage RM, Bank AJ: Right Ventricular Pacing and Mechanical Dyssynchrony, Electrophysiology – From Plants to Heart 2012. Ed.: Dr. Saeed Oraii, DOI: 10.5772/28691.
- Manolis AS: The deleterious consequences of right ventricular apical pacing: time to seek alternate site pacing. Pacing Clin Electrophysiol 2006, 29, 298–315.
- Robboy SJ, Harthorne JW, Leinbach RC, Sanders CA, Austen WG: Autopsy findings with permanent pervenous pacemakers. Circulation 1969, 39, 495–501.
- Sobol BJ, Botex G, Emirgil C, Gissen H: Valvular Insufficiency Occurring During Cardiac Catheterization. Am J Cardiol 1964, 14, 533–536.
- Sakai M, Ohkawa S, Ueda K, Kin H, Watanabe C, Matsushita S, Kuramoto K, Sugiura M, Takahashi T, Takenaka K: Tricuspid regurgitation induced by transvenous right ventricular pacing: echocardiographic and pathological observations. J Cardiol 1987, 17, 311–320.
- Leibowitz DW, Rosenheck S, Pollak A, Geist M, Gilon D: Transvenous pacemaker leads do not worsen tricuspid regurgitation: a prospective echocardiographic study. Cardiology 2000, 93, 74–77.
- Krupa W, Kozłowski D, Tybura S, Świątecka G, Raczak G, Kubica J, Sielski S: Kliniczno-echokardiograficzna ocena niedomykalności zastawki trójdzielnej u pacjentów ze stałą stymulacją serca. Folia Cardiol 2004, 11, 10, 751–763.
- Paniagua D, Aldrich HR, Lieberman EH, Lamas GA, Agatston AS: Increased prevalence of significant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol 1998, 1, 82, 1130–1132.
- Nath J, Foster E, Heidenreich PA: Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004, 43, 405–409.
- Stambler BS: Left Atrial Mechanical Function and Right Ventricular Apical Pacing: Making the Connections Between the Atrium and Ventricle Clearer. J Cardiovasc Electrophysiol 2011, 22, 875–877. DOI: 10.1111/j.1540- 8167.2011.02063.x
- “Indication for cardiac resynchronization therapy in patients with permanent atrial fibrillation” – Eur Heart J 2013, 34, 2281–2329.
- Miranda R, Almeida S, Brandão L, Alvarenga C, Ribeiro L, Almeida AR, Carrageta M: Acute severe mitral regurgitation as an early complication of pacemaker implantation. Europace 2010, 12, 1791–1792. DOI:10.1093/ /europace/euq191. Epub 2010 Jul 1.
- Lewicka-Nowak E, Dabrowska-Kugacka A, Tybura S, Krzymińska-Stasiuk E, Wilczek R, Staniewicz J, Swiatecka G, Raczek G: Right ventricular apex versus right ventricular outflow tract pacing: prospective, randomised, long-term clinical and echocardiographic evaluation. Kardiol Pol 2006, 64, 1082–1091, 1092–1093.
- Jean-Benoît Thambo, Bordachar P, Garrigue S, Lafitte S, Sanders P, Reuter S, Girardot R, Crepin D, Reant P, Roudaut R, Jaïs P, Haïssaguerre M, Clementy J, Jimenez M: Detrimental Ventricular Remodeling in Patients With Congenital Complete Heart Block and Chronic Right Ventricular Apical Pacing. Circulation 2004, 110, 3766–3772.
- Abreu CD, Nunes Mdo C, Barbosa MM, Rocha MO, Ribeiro AL: Ventricular dyssynchrony and increased BNP levels in right ventricular apical pacing. Arq Bras Cardiol 2011, 97, 156–162. Epub 2011 Jun 10.
- Stambler BS, Ellenbogen K, Zhang X, Porter TR, Xie F, Malik R, Small R, Burke M, Kaplan A, Nair L, Belz M, Fuenzalida C, Gold M, Love C, Sharma A, Silverman R, Sogade F, Van Natta B, Wilkoff BL, ROVA Investigators: Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol 2003, 14, 1180–1186.
- Simantirakis EN, Prassopoulos VK, Chrysostomakis SI, Kochiadakis GE, Koukouraki SI, Lekakis JP, Karkavitsas NS, Vardas PE: Effects of asynchronous ventricular activation on myocardial adrenergic innervation in patients with permanent dual-chamber pacemakers; an I(123)-metaiodobenzylguanidine cardiac scintigraphic study. Eur Heart J 2001, 22, 323–332.
- Wyman BT1, Hunter WC, Prinzen FW, McVeigh ER: Mapping propagation of mechanical activation in the paced heart with MRI tagging. Am J Physiol 1999, 276, (3 Pt 2), 881–891.
- Bauer A, Watanabe MA, Barthel P, Schneider R, Ulm K, Schmidt G: QRS duration and late mortality in unselected post-infarction patients of the revascularization era. Eur Heart J 2006, 27, 427–433. Epub 2005 Dec 7.
- Wilkoff BL, Cook JR, Epstein AE, Greene HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A: Dual Chamber and VVI Implantable Defibrillator Trial Investigators: Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002, 25, 288, 3115–3123.
- Zhang Q, Fang F, Yip GW, Chan JY, Shang Q, Fung JW, Chan AK, Liang YJ, Yu CM: Difference in prevalence and pattern of mechanical dyssynchrony in left bundle branch block occurring in right ventricular apical pacing versus systolic heart failure. Am Heart J 2008, 156, 989–995. DOI: 10.1016/j.ahj.2008.06.027. Epub 2008 Sep 11.
- Sharma AD, Rizo-Patron C, Hallstrom AP, O’Neill GP, Rothbart S, Martins JB, Roelke M, Steinberg JS, Greene HL; DAVID Investigators: Percent right ventricular pacing predicts outcomes in the DAVID trial. Heart Rhythm 2005, 2, 830–834.
- Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA; MOde Selection Trial Investigators: Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003, 17, 107, 2932–2937. Epub 2003 Jun 2.
- Cowell R, Morris-Thurgood J, Ilsley C, Paul V: Septal short atrioventricular delay pacing: additional hemodynamic improvements in heart failure. Pacing Clin Electrophysiol 1994, 17, 1980–1983.
- Giudici MC, Karpawich PP: Alternative site pacing: it’s time to define terms. Pacing Clin Electrophysiol 1999, 22, (4 Pt 1), 551–553.
- McGavigan AD, Roberts-Thomson KC, Hillock RJ, Stevenson IH, Mond HG: Right ventricular outflow tract pacing: radiographic and electrocardiographic correlates of lead position. Pacing Clin Electrophysiol 2006, 29, 1063–1068.
- Yamano T, Kubo T, Takarada S, Ishibashi K, Komukai K, Tanimoto T, Ino Y, Kitabata H, Hirata K, Tanaka A, Imanishi T, Akasaka T: Advantage of right ventricular outflow tract pacing on cardiac function and coronary circulation in comparison with right ventricular apex pacing. J Am Soc Echocardiogr 2010, 23, 1177–1182. DOI: 10.1016/j.echo.2010.07.017. Epub 2010 Aug 30.
- Victor F, Leclercq C, Mabo P, Pavin D, Deviller A, de Place C, Pezard P, Victor J, Daubert C: Optimal right ventricular pacing site in chronically implanted patients: a prospective randomized crossover comparison of apical and outflow tract pacing. J Am Coll Cardiol 1999, 33, 311–316.
- Cano O, Osca J, Sancho-Tello MJ, Sánchez JM, Ortiz V, Castro JE, Salvador A, Olagüe J: Comparison of effectiveness of right ventricular septal pacing versus right ventricular apical pacing. Am J Cardiol 2010, 15, 105, 1426– 1432. DOI: 10.1016/j.amjcard.2010.01.004. Epub 2010 Mar 30.
- Cho GY, Kim MJ, Park JH, Kim HS, Youn HJ, Kim KH, Song JK: Comparison of ventricular dyssynchrony according to the position of right ventricular pacing electrode: a multi-center prospective echocardiographic study. J Cardiovasc Ultrasound 2011, 19, 15–20.
- Zanon F, Bacchiega E, Rampin L, Aggio S, Baracca E, Pastore G, Marotta T, Corbucci G, Roncon L, Rubello D, Prinzen FW: Direct His bundle pacing preserves coronary perfusion compared with right ventricular apical pacing: a prospective, cross-over mid-term study. Europace 2008, 10, 580–587. DOI: 10.1093/europace/eun089. Epub 2008 Apr 11.
- Deshmukh P, Casavant DA, Romanyshyn M, Anderson K: Permanent, direct His-bundle pacing: a novel approach to cardiac pacing in patients with normal His-Purkinje activation. Circulation 2000, 29, 101, 869–877.
- Kindermann M, Hennen B, Jung J, Geisel J, Böhm M, Fröhlig G: Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol 2006, 47, 1927–1937. Epub 2006 Apr 24.
- Brignole M, Botto G, Mont L, Iacopino S, De Marchi G, Oddone D, Luzi M, Tolosana JM, Navazio A, Menozzi C: Cardiac resynchronization therapy in patients undergoing atrioventricular junction ablation for permanent atrial fibrillation: a randomized trial. Eur Heart J 2011, 32, 2420-9. DOI: 10.1093/eurheartj/ehr162. Epub 2011 May 23.
- “Indications for cardiac resynchronization therapy in patients in sinus rhythm” – Eur Heart J 2013, 34, 2281–2329.
- Vlay SC: Right ventricular outflow tract pacing: practical and beneficial. A 9-year experience of 460 consecutive implants. Pacing Clin Electrophysiol 2006, 29, 1055–1062.
- Hillock RJ, Mond HG: Pacing the Right Ventricular Outflow Tract Septum – Are We there Yet? Asia-Pacific Cardiol 2007, 1, 57–59.
- Giudici MC, Barold SS, Paul DL, Schrumpf PE, Van Why KJ, Orias DW: Right ventricular outflow tract placement of defibrillation leads: five year experience. Pacing Clin Electrophysiol 2004, 27, 443–446.
- Erdoğan O, Aktöz M, Altun A: Long-term safety and efficacy of right ventricular outflow tract pacing in patients with permanent pacemakers. Anadolu Kardiyol Derg 2008, 8, 350–353.
- Foley PW, Muhyaldeen SA, Chalil S, Smith RE, Sanderson JE, Leyva F: Long-term effects of upgrading from right ventricular pacing to cardiac resynchronization therapy in patients with heart failure. Europace 2009, 11, 495–501. DOI: 10.1093/europace/eup037.
- Indications for upgraded or de novo cardiac resynchronization therapy in patients with conventional pacemaker indications and heart failure. Eur Heart J 2013, 34, 2281–2329.