open access

Vol 10, No 6 (2015)
Review Papers
Published online: 2016-01-11
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Effect of chronic right ventricular pacing — electrophysiological, neurohumoral, histopathological, and hemodynamic aspects

Leszek Chęciński, Agnieszka Sławuta, Joanna Moszczyńska-Stulin, Caroline Chęcińska, Jacek Gajek
DOI: 10.5603/FC.2015.0078
·
Folia Cardiologica 2015;10(6):410-417.

open access

Vol 10, No 6 (2015)
Review Papers
Published online: 2016-01-11

Abstract

Highly symptomatic patients with a sinus node disease constitute a relatively large group undergoing a permanent pacemaker implantation. There is no proof for lifesaving influence of this procedure. Nevertheless, the clinical symptoms decrease, with a simultaneous increase of patients’ wellbeing. This symptomatic impact of permanent pacing is indisputable. However, a careful weighting of the indications to the pacemaker implantation is required in every patient to balance the benefits and disadvantages of a chronic heart stimulation. The permanent right ventricle pacing contributes to unfavourable histological changes in the heart muscle structure, disturbed myocardial blood flow and neurohumoral activation, leading to degenerative processes interfering with diastolic and systolic functions of the ventricles. Those changes are in particular intensively seen in patients with compromised left ventricular systolic function. The first attempts to find better ventricular pacing sites and to ascertain more physiological ventricular contraction were made as early as in 1990s. These attempts were inspired by reports from many clinical studies emphasising the deleterious effect of chronic right ventricular pacing and by the fact that active fixation leads were already in the market. In many clinical trials the alternative pacing sites were studied to prove the concept of better systolic function during pacing and/or lower the percentage of pacing in the ventricle. An appropriate pacing site choice, the programming of hysteresis or an adequate atrioventricular delay are of particular importance for the purpose of either avoiding or reducing unfavourable chronic effects of ventricular pacing. On the basis of numerous literature data, the authors indicate the possibilities to avoid deleterious properties of the chronic right ventricular pacing by the use of currently available pacing modes and pacing leads implantation techniques.

Abstract

Highly symptomatic patients with a sinus node disease constitute a relatively large group undergoing a permanent pacemaker implantation. There is no proof for lifesaving influence of this procedure. Nevertheless, the clinical symptoms decrease, with a simultaneous increase of patients’ wellbeing. This symptomatic impact of permanent pacing is indisputable. However, a careful weighting of the indications to the pacemaker implantation is required in every patient to balance the benefits and disadvantages of a chronic heart stimulation. The permanent right ventricle pacing contributes to unfavourable histological changes in the heart muscle structure, disturbed myocardial blood flow and neurohumoral activation, leading to degenerative processes interfering with diastolic and systolic functions of the ventricles. Those changes are in particular intensively seen in patients with compromised left ventricular systolic function. The first attempts to find better ventricular pacing sites and to ascertain more physiological ventricular contraction were made as early as in 1990s. These attempts were inspired by reports from many clinical studies emphasising the deleterious effect of chronic right ventricular pacing and by the fact that active fixation leads were already in the market. In many clinical trials the alternative pacing sites were studied to prove the concept of better systolic function during pacing and/or lower the percentage of pacing in the ventricle. An appropriate pacing site choice, the programming of hysteresis or an adequate atrioventricular delay are of particular importance for the purpose of either avoiding or reducing unfavourable chronic effects of ventricular pacing. On the basis of numerous literature data, the authors indicate the possibilities to avoid deleterious properties of the chronic right ventricular pacing by the use of currently available pacing modes and pacing leads implantation techniques.

Get Citation

Keywords

chronic heart pacing, right ventricle outflow tract pacing, pacemaker syndrome, alternative ventricular pacing sites

About this article
Title

Effect of chronic right ventricular pacing — electrophysiological, neurohumoral, histopathological, and hemodynamic aspects

Journal

Folia Cardiologica

Issue

Vol 10, No 6 (2015)

Pages

410-417

Published online

2016-01-11

DOI

10.5603/FC.2015.0078

Bibliographic record

Folia Cardiologica 2015;10(6):410-417.

Keywords

chronic heart pacing
right ventricle outflow tract pacing
pacemaker syndrome
alternative ventricular pacing sites

Authors

Leszek Chęciński
Agnieszka Sławuta
Joanna Moszczyńska-Stulin
Caroline Chęcińska
Jacek Gajek

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