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Burri H, Starck C, Auricchio A, Biffi M, Burri M, D'Avila A, Deharo JC, Glikson M, Israel C, Lau CP, Leclercq C, Love CJ, Nielsen JC, Vernooy K, Dagres N, Boveda S, Butter C, Marijon E, Braunschweig F, Mairesse GH, Gleva M, Defaye P, Zanon F, Lopez-Cabanillas N, Guerra JM, Vassilikos VP, Martins Oliveira M. EHRA expert consensus statement and practical guide on optimal implantation technique for conventional pacemakers and implantable cardioverter-defibrillators: endorsed by the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS), and the Latin-American Heart Rhythm Society (LAHRS). Europace 2021; 23:983-1008. [PMID: 33878762 DOI: 10.1093/europace/euaa367] [Citation(s) in RCA: 82] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
With the global increase in device implantations, there is a growing need to train physicians to implant pacemakers and implantable cardioverter-defibrillators. Although there are international recommendations for device indications and programming, there is no consensus to date regarding implantation technique. This document is founded on a systematic literature search and review, and on consensus from an international task force. It aims to fill the gap by setting standards for device implantation.
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Affiliation(s)
- Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva, Switzerland
| | - Christoph Starck
- Department of Cardiothoracic and Vascular Surgery, German Heart Center, Berlin, Augustenburger Pl. 1, 13353 Berlin, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Steinbeis University Berlin, Institute (STI) of Cardiovascular Perfusion, Berlin, Germany
| | - Angelo Auricchio
- Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland
| | - Mauro Biffi
- Azienda Ospedaliero-Universitaria di Bologna, Policlinico S.Orsola-Malpighi, Università di Bologna, Bologna, Italy
| | - Mafalda Burri
- Division of Scientific Information, University of Geneva, Rue Michel Servet 1, 1211 Geneva, Switzerland
| | - Andre D'Avila
- Serviço de Arritmia Cardíaca-Hospital SOS Cardio, 2 Florianópolis, SC, Brazil.,Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | | | - Carsten Israel
- Department of Cardiology, Bethel-Clinic Bielefeld, Burgsteig 13, 33617, Bielefeld, Germany
| | - Chu-Pak Lau
- Division of Cardiology, University of Hong Kong, Queen Mary Hospital, Pok Fu Lam, Hong Kong
| | | | - Charles J Love
- Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Jens Cosedis Nielsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 161, 8200 Aarhus, Denmark
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Radboud University Medical Center (Radboudumc), Nijmegen, The Netherlands
| | | | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Serge Boveda
- Heart Rhythm Department, Clinique Pasteur, 31076 Toulouse, France
| | - Christian Butter
- Department of Cardiology, Heart Center Brandenburg, Chefarzt, Abteilung Kardiologie, Berlin, Germany
| | - Eloi Marijon
- University of Paris, Head of Cardiac Electrophysiology Section, European Georges Pompidou Hospital, 20 Rue Leblanc, 75908 Paris Cedex 15, France
| | | | - Georges H Mairesse
- Department of Cardiology-Electrophysiology, Cliniques du Sud Luxembourg-Vivalia, rue des Deportes 137, BE-6700 Arlon, Belgium
| | - Marye Gleva
- Washington University in St Louis, St Louis, MO, USA
| | - Pascal Defaye
- CHU Grenoble Alpes, Unite de Rythmologie, Service De Cardiologie, CS10135, 38043 Grenoble Cedex 09, France
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | - Jose M Guerra
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, Universidad Autonoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Vassilios P Vassilikos
- Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.,3rd Cardiology Department, Hippokrateio General Hospital, Thessaloniki, Greece
| | - Mario Martins Oliveira
- Department of Cardiology, Hospital Santa Marta, Rua Santa Marta, 1167-024 Lisbon, Portugal
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Garweg C, Vandenberk B, Foulon S, Haemers P, Ector J, Willems R. Leadless pacing with Micra TPS: A comparison between right ventricular outflow tract, mid-septal, and apical implant sites. J Cardiovasc Electrophysiol 2019; 30:2002-2011. [PMID: 31338871 DOI: 10.1111/jce.14083] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 07/12/2019] [Accepted: 07/14/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND With its steerable transcatheter delivery system, the Micra can be deployed in nonapical positions within the right ventricle, potentially allowing reduction of the paced QRS width. We sought to evaluate the safety and long-term performance of the right ventricular outflow tract (RVOT) pacing using the Micra transcatheter pacing system (TPS). We also compared the paced QRS between RVOT, mid-septal, and apical implant positions. METHODS All patients who underwent a Micra TPS implantation at the University Hospitals of Leuven were enrolled in this observational study. Right ventricular (RV) position of the device was assessed on per-procedural ventriculography. Paced QRS was analyzed and follow-up completed at 1 month and then every 6 months. RESULTS Among the 133 patients included (mean follow-up: 13 ± 11 months), 45 were implanted in the RVOT, 58 midseptally, and 30 at the apex. All implant procedures were successful and no pericardial effusion was encountered within the 30 days post-implant. Two major complications were reported with devices implanted at the apex. Pacing impedance was significantly higher in the RVOT compared to the mid-septal and apical position (P < .001). Pacing threshold and R-wave amplitude did not differ over time in either position. The median narrowest paced QRS duration was observed in the RVOT (142 ms) compared to mid-septal (159 ms; P < .001), and apical position (181 ms; P < .001). CONCLUSION Implantation of the Micra TPS in the RVOT is safe and feasible. Electrical performance over time was comparable to mid-septal and apical positions. The narrowest paced QRS complexes is achieved with RVOT pacing.
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Affiliation(s)
- Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Stefaan Foulon
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Peter Haemers
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.,Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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Worsnick SA, Sharma PS, Vijayaraman P. Right Ventricular Septal Pacing: A Paradigm Shift. J Innov Card Rhythm Manag 2018; 9:3137-3146. [PMID: 32494491 PMCID: PMC7252807 DOI: 10.19102/icrm.2018.090501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/27/2017] [Indexed: 11/06/2022] Open
Abstract
The right ventricular (RV) apex has been considered to be the primary site for ventricular lead implantation since the original descriptions of permanent pacing. However, long-term RV apical pacing has been shown to have negative effects on ventricular function and hemodynamics as a result of ventricular dyssynchrony. Alternative sites of ventricular pacing, particularly the RV septum and His bundle, have been evaluated for patients with a need for long-term ventricular pacing. In this article, we review the available data on the use of these alternative sites for RV pacing.
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Singh H, Patel CD, Sharma G, Naik N. Comparison of left ventricular systolic function and mechanical dyssynchrony using equilibrium radionuclide angiography in patients with right ventricular outflow tract versus right ventricular apical pacing: A prospective single-center study. J Nucl Cardiol 2015; 22:903-11. [PMID: 25609582 DOI: 10.1007/s12350-014-0033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Chronic ventricular pacing is known to adversely affect left ventricular (LV) function. Studies comparing right ventricular outflow tract (RVOT) pacing with RV apical (RVA) pacing have shown heterogeneous outcomes. Our aim was to objectively assess LV function and mechanical dyssynchrony in patients with RVOT and RVA pacing using equilibrium radionuclide angiography (ERNA). METHODS Fifty-one patients who underwent permanent pacemaker implantation and had normal LV function were prospectively included. Twenty-nine patients had pacemaker lead implanted in the RVOT and 22 at the RVA site. All patients underwent ERNA within 5 days post-pacemaker implantation and follow-up studies at 6 and 12 months. Standard deviation of LV mean phase angle (SD LV mPA) expressed in degrees, which was derived by Fourier first harmonic analysis of phase images, was used to quantify left intraventricular dyssynchrony. RESULTS No significant difference was observed between the two groups with respect to indication (P = .894), Type/mode (P = .985), and percentage of ventricular pacing (P = .352). Paced QRS duration was significantly longer in RVA group than RVOT group (P = .05). There was no statistically significant difference between the RVA and RVOT groups at baseline with respect to LVEF (P = .596) and SD LV mPA (P = .327). Within the RVA group, a significant decline in LVEF was observed over 12-month follow-up (from 57.3% ± 5.32% to 55.6% ± 6.25%; P = .012). In the RVOT group, the change in LVEF was not statistically significant (from 56.7% ± 4.08% to 54.3% ± 6.63%; P = .159). No significant change in SD LV mPA was observed over 12-month follow-up within the RVA group (from 10.5 ± 2.58° to 10.4 ± 3.54°; P = 1.000) as well as in the RVOT group (from 9.7 ± 3.28° to 9.4 ± 2.85°; P = .769). However, between the RVA and RVOT groups, no significant difference was observed at 12-month follow-up in terms of LVEF and dyssynchrony (LVEF P = .488; SD LV mPA P = .296). CONCLUSION No significant difference was observed between RVOT and RVA groups with regard to LV function and synchrony over a 12-month follow-up. RVOT pacing offers may lead to better preservation of LV function on longer follow-up.
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Affiliation(s)
- Harmandeep Singh
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Chetan D Patel
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Gautam Sharma
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India
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Madershahian N, Scherner M, Weber C, Kuhn E, Choi YH, Slottosch I, Wahlers T. Temporary biventricular pacing improves bypass graft flows in coronary artery bypass graft patients with permanent atrial fibrillation. Interact Cardiovasc Thorac Surg 2015; 21:435-40. [PMID: 26109629 DOI: 10.1093/icvts/ivv169] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/12/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We have previously demonstrated the impact of univentricular pacing modalities on bypass graft flow (BGF) in the coronary artery bypass graft (CABG) patient with permanent atrial fibrillation (AF). The aim of the present study was to determine the mechanism of this improved coronary conduit and, in addition, to explore the possible benefits with biventricular pacing in patients with and without severe left ventricular dysfunction. METHODS In 43 CABG patients [mean age 69.5 ± 1.3 years; ejection fraction (EF) 49 ± 2%] with AF, we analysed coronary vascular resistances (CVRs) and the contemporary changes in the BGF obtained during right ventricular outflow tract (RVOT), right- (RV), left- (LV) and right-left ventricular pacing (biventricular pacing, BiVP) using the ultrasonic transit-time methodology. RESULTS BiVP resulted in the highest percentage decrease of CVR in the overall study group by 17.5 ± 3.0% (P < 0.001), followed by RVOT pacing with 13.9 ± 3.9%. Accordingly, the highest mean BGF was achieved during BiVP, resulting in a 21.6 ± 2.6% increase when compared with no pacing and 16 ± 3.7% when compared with RV pacing. Analysis of patients according to their preoperative LV function (EF ≥50%, n = 26; EF <50%, n = 17) showed significantly lower CVR (P < 0.037) and higher BGF during BiVP in patients with lower EF. CONCLUSIONS Placement of an additional LV pacing wire offered a significant improvement in BGF by minimizing CVR in patients with AF and poor EF.
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Affiliation(s)
- Navid Madershahian
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Maximilian Scherner
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Carolyn Weber
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Elmar Kuhn
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Ingo Slottosch
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Cologne, Germany
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6
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Zou C, Song J, Li H, Huang X, Liu Y, Zhao C, Shi X, Yang X. Right ventricular outflow tract septal pacing is superior to right ventricular apical pacing. J Am Heart Assoc 2015; 4:jah3942. [PMID: 25896891 PMCID: PMC4579934 DOI: 10.1161/jaha.115.001777] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The effects of right ventricular apical pacing (RVAP) and right ventricular outflow tract (RVOT) septal pacing on atrial and ventricular electrophysiology have not been thoroughly compared. Methods and Results To identify a more favorable pacing strategy with fewer adverse effects, 80 patients who had complete atrioventricular block with normal cardiac function and who were treated with either RVAP (n=42) or RVOT septal pacing (n=38) were recruited after an average of 2 years of follow‐up. The data from electrocardiography and echocardiography performed before pacemaker implantation and at the end of follow‐up were collected. The patients in the RVOT septal pacing and RVAP groups showed similar demographic and clinical characteristics before pacing treatments. After a mean follow‐up of 2 years, the final maximum P‐wave duration; P‐wave dispersion; Q‐, R‐, and S‐wave complex duration; left atrial volume index; left ventricular end‐systolic diameter; ratio of transmitral early diastolic filling velocity to mitral annular early diastolic velocity; and interventricular mechanical delay in the RVOT septal pacing group were significantly less than those in the RVAP group (P<0.05). The final left ventricular ejection fraction of the RVOT septal pacing group was significantly higher than that of the RVAP group (P<0.05). Conclusions Compared with RVAP, RVOT septal pacing has fewer adverse effects regarding atrial electrical activity and structure in patients with normal cardiac function.
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Affiliation(s)
- Cao Zou
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Jianping Song
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Hui Li
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
| | - Xingmei Huang
- Department of Electrocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (X.H., Y.L.)
| | - Yuping Liu
- Department of Electrocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (X.H., Y.L.)
| | - Caiming Zhao
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., X.S.)
| | - Xin Shi
- Department of Echocardiography, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., X.S.)
| | - Xiangjun Yang
- Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou, China (C.Z., J.S., H.L., X.Y.)
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Chen K, Mao Y, Liu SH, Wu Q, Luo QZ, Pan WQ, Jin Q, Zhang N, Ling TY, Chen Y, Gu G, Shen WF, Wu LQ. Is right ventricular mid-septal pacing superior to apical pacing in patients with high degree atrio-ventricular block and moderately depressed left ventricular function? J Zhejiang Univ Sci B 2015; 15:507-14. [PMID: 24903987 DOI: 10.1631/jzus.b1400034] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We are aimed to investigate whether right ventricular mid-septal pacing (RVMSP) is superior to conventional right ventricular apical pacing (RVAP) in improving clinical functional capacity and left ventricular ejection fraction (LVEF) for patients with high-degree atrio-ventricular block and moderately depressed left ventricle (LV) function. METHODS Ninety-two patients with high-degree atrio-ventricular block and moderately reduced LVEF (ranging from 35% to 50%) were randomly allocated to RVMSP (n=45) and RVAP (n=47). New York Heart Association (NYHA) functional class, echocardiographic LVEF, and distance during a 6-min walk test (6MWT) were determined at 18 months after pacemaker implantation. Serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured using an enzyme-linked immunosorbent assay (ELISA) kit. RESULTS Compared with baseline, NYHA functional class remained unchanged at 18 months, distance during 6MWT (485 m vs. 517 m) and LVEF (36.7% vs. 41.8%) were increased, but BNP levels were reduced (2352 pg/ml vs. 710 pg/ml) in the RVMSP group compared with those in the RVAP group, especially in patients with LVEF 35%-40% (for all comparisons, P<0.05). However, clinical function capacity and LV function measurements were not significantly changed in patients with RVAP, despite the pacing measurements being similar in both groups, such as R-wave amplitude and capture threshold. CONCLUSIONS RVMSP provides a better clinical utility, compared with RVAP, in patients with high-degree atrioventricular block and moderately depressed LV function whose LVEF levels ranged from 35% to 40%.
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Affiliation(s)
- Kang Chen
- Department of Cardiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China; Outpatient Department, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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Akerström F, Pachón M, Puchol A, Jiménez-López J, Segovia D, Rodríguez-Padial L, Arias MA. Chronic right ventricular apical pacing: adverse effects and current therapeutic strategies to minimize them. Int J Cardiol 2014; 173:351-60. [PMID: 24721486 DOI: 10.1016/j.ijcard.2014.03.079] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 01/27/2014] [Accepted: 03/12/2014] [Indexed: 02/07/2023]
Abstract
The permanent cardiac pacemaker is the only effective therapy for patients with symptomatic bradycardia and hundreds of millions are implanted worldwide every year. Despite its undisputed clinical benefits, the last two decades have drawn much attention to the negative effects associated with long-term pacing of the right ventricle (RV). Experimental and clinical studies have shown that RV pacing produces ventricular dyssynchrony, similar to that of left bundle branch block, with consequent detrimental effects on cardiac structure and function, with adverse clinical outcomes such as atrial fibrillation, heart failure and death. Although clinical evidence largely comes from subanalyses of pacemaker and implantable cardiac defibrillator studies, there is strong evidence that patients with reduced left ventricular function are at high risk of suffering from the detrimental effects of long-term RV pacing. Biventricular pacing in cardiac resynchronization therapy devices can prevent ventricular dyssynchrony and has emerged as an attractive option in this patient group with promising results and more clinical studies underway. Moreover, there is evidence that specific pacemaker algorithms that minimize RV pacing can reduce the negative effects of RV stimulation on cardiac function and may also prevent clinical deterioration. The extent of the long-term clinical effects of RV pacing in patients with normal ventricular function and how to prevent this are less clear and subject to future investigation.
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Affiliation(s)
- Finn Akerström
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Marta Pachón
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Alberto Puchol
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Jesús Jiménez-López
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Diana Segovia
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Luis Rodríguez-Padial
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain
| | - Miguel A Arias
- Cardiac Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hospital Virgen de la Salud, Toledo, Spain.
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9
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Development of mitral and tricuspid regurgitation in right ventricular apex versus right ventricular outflow tract pacing. J Interv Card Electrophysiol 2014; 40:81-6. [DOI: 10.1007/s10840-014-9878-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
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10
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Elder DHJ, Lang CC, Choy AM. Pacing-induced heart disease: understanding the pathophysiology and improving outcomes. Expert Rev Cardiovasc Ther 2014; 9:877-86. [DOI: 10.1586/erc.11.82] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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11
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Molina L, Sutton R, Gandoy W, Reyes N, Lara S, Limón F, Gómez S, Orihuela C, Salame L, Moreno G. Medium-term effects of septal and apical pacing in pacemaker-dependent patients: a double-blind prospective randomized study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:207-14. [PMID: 23998710 PMCID: PMC4265201 DOI: 10.1111/pace.12257] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/15/2013] [Accepted: 07/18/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pacing the right ventricle is established practice, but there remains controversy as to the optimal site to preserve hemodynamic function. AIMS To evaluate clinical and hemodynamic differences between apical and septal pacing in pacemaker-dependent patients. METHODS Patients receiving their first pacemaker for advanced atrioventricular block, with the atria in sinus rhythm, were randomized to receive apical (Group A) or septal (Group S) ventricular leads. After implant, with the device programmed VVI 70 beats/min fixed rate, patients underwent a 6-minute walk test and a transthoracic echocardiogram. Then, DDDR was programmed at nominal settings. The same tests were performed at 6 months and 12 months follow-up. If ventricular pacing was less than 98%, the patient was excluded. RESULTS A total of 142 patients were included in the study. During the study year, 71 (50%) were excluded for not fulfilling the condition of 98% ventricular pacing. Groups A and S had 34 and 37 patients, respectively. Age and gender were similar in the groups. At implant, QRS duration was significantly greater in Group A (158 ms) than Group S (146 ms; P = 0.018), and the QRS axis was different: -74.5° in Group A and 1° in Group S (P < 0.001). At 1 year, the 6-minute walk improved significantly in both groups: Group A 15% (P = 0.048) and Group S 24% (P = 0.001). Left ventricular ejection fraction (LVEF) increased from 0.57 to 0.61 (P = 0.008) in Group S, without significant change in Group A. CONCLUSIONS After 1 year, pacemaker-dependent patients with septal ventricular leads have better clinical and functional (LVEF) outcome.
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Affiliation(s)
- Luis Molina
- Arrhythmia Laboratory of the Universidad Nacional Autónoma de México (UNAM) en Hospital General de México, Mexico City, Medico
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12
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Singal A, Hussain N, Marcaccini R, Weinhaus AJ, Iaizzo PA. Conus Arteriosus as an Alternate Pacing Site. J Med Device 2013. [DOI: 10.1115/1.4024493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ashish Singal
- Department of Biomedical Engineering, University of Minnesota; Department of Surgery, University of Minnesota
| | | | | | | | - Paul A. Iaizzo
- Department of Biomedical Engineering, University of Minnesota; Department of Integrative Biology & Physiology, University of Minnesota; Department of Surgery, University of Minnesota; Department of Institute of Engineering in Medicine, University of Minnesota
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13
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Da Costa A, Gabriel L, Romeyer-Bouchard C, Géraldine B, Gate-Martinet A, Laurence B, Levallois M, Isaaz K. Focus on right ventricular outflow tract septal pacing. Arch Cardiovasc Dis 2013; 106:394-403. [PMID: 23850059 DOI: 10.1016/j.acvd.2012.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 08/04/2012] [Accepted: 08/08/2012] [Indexed: 10/26/2022]
Abstract
Experimental and clinical studies have shown that right ventricular apical pacing may result in long-term deleterious effects on account of its negative impact on left ventricular remodeling through desynchronization. This risk appears more pronounced in patients with even moderate left ventricular dysfunction and generally occurs after at least 1 year of pacing. As right ventricular apical pacing may be associated with the development of organic mitral insufficiency, other sites that allow for more physiological stimulation, such as right ventricular outflow tract septal pacing, have been developed, with good feasibility and reproducibility. However, the prospective randomized studies and meta-analyses to date have only demonstrated a modest effect on ejection fraction in the medium term, without any significant effect on quality of life and morbimortality. However, the absence of a favorable effect for right ventricular outflow tract septal pacing compared with right ventricular apical pacing in terms of clinical manifestations and patient prognosis appears to be more associated with the designs of these studies, which were not homogeneous with regard to methodology used, judgment criteria, follow-up and, especially, statistical power. Two randomized prospective multicentre studies are currently ongoing in order to evaluate the favorable effect of infundibular septal pacing, when considering the indirect negative effects of right ventricular apical pacing as reported in the literature.
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Affiliation(s)
- Antoine Da Costa
- Service de Cardiologie, Université Jean Monnet, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, France.
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Osmancik P, Stros P, Herman D, Curila K, Petr R. The insufficiency of left anterior oblique and the usefulness of right anterior oblique projection for correct localization of a computed tomography-verified right ventricular lead into the midseptum. Circ Arrhythm Electrophysiol 2013; 6:719-25. [PMID: 23742805 DOI: 10.1161/circep.113.000232] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of the study was to verify the correct anchoring location for the tip of the right ventricular lead using cardiac computed tomography and to assess the best fluoroscopic and ECG criteria associated with the correct location of the electrode into the midseptum. METHODS AND RESULTS Patients indicated to pacemaker implantation were prospectively enrolled. The right ventricular lead was implanted into the midseptum according to standard criteria in left anterior oblique 40 view. The cardiac shadow on the right anterior oblique 30 was divided into 4 quadrants perpendicular to the lateral cardiac silhouette and the position of the lead tip was analyzed. The exact position of the lead tip was assessed using computed tomography. Of 51 patients, the right ventricular lead was anchored midseptum in 21 (41.2%; MS group). In 30 patients (58.8%; non-MS group), the lead was anchored in the adjacent anterior wall. The angle between the lead and horizontal axis on the left anterior oblique was similar in both groups. The non-MS group was associated with shorter distances between the tip and the cardiac contours in the right anterior oblique 30 (96.7% of leads in the non-MS group were in the outer quadrant versus 9.6% in the MS group; P<0.001). The presence of the lead in the middle or inferior quadrants was independently associated with correct midseptum placement with positive predictive value of 94.7%. CONCLUSIONS Despite the optimal shape of the left anterior oblique, substantial numbers of leads were not anchored in the midseptum. Knowing the right anterior oblique 30 lead position can ensure proper midseptal placement.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Department of Cardiology, 3rd Medical School, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Kikuchi M, Tanno K, Miyoshi F, Munetsugu Y, Onuma Y, Ito H, Adachi T, Kawamura M, Asano T, Kobayashi Y. Long-term effectiveness of right septal pacing vs. right apical pacing in patients with atrioventricular block. J Arrhythm 2012. [DOI: 10.1016/j.joa.2012.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Sideris S, Aggeli C, Poulidakis E, Gatzoulis K, Vlaseros I, Avgeropoulou K, Felekos I, Sotiropoulos I, Stefanadis C, Kallikazaros I. Bifocal right ventricular pacing: an alternative way to achieve resynchronization when left ventricular lead insertion is unsuccessful. J Interv Card Electrophysiol 2012; 35:85-91. [PMID: 22552761 DOI: 10.1007/s10840-012-9681-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 03/05/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE Bifocal pacing in the right ventricle is an option for patients with end-stage heart failure in whom biventricular pacing is not possible, due to failure in left ventricular (LV) lead insertion. The purpose of this prospective study was to document the clinical response of these patients, after bifocal pacing. METHODS From the patients referred for cardiac resynchronization therapy (CRT), from 2009 to 2010, 13 cardiac CRT candidates who underwent unsuccessful LV lead implantation were included. The bifocal system's leads were implanted in the right atrium, the right ventricular (RV) apex, and the RV outflow tract. Initial patient assessment and follow-up evaluation after 6 months included clinical criteria, echocardiographic indices, and biochemical parameters. RESULTS From 13 patients (age 68 ± 9 years, nine male), 10 improved clinically. New York Heart Association classification was reduced by one grade (from 3.6 ± 0.5 to 2.8 ± 0.8, p < 0.005 and respectively), while hospitalizations in 6-month time were reduced from three to one (p < 0.001). Six-minute walk test (in meters) increased from 176 ± 86 to 297 ± 91 (p < 0.001) and quality of life improved (EQ-VAS scale changed from 42 ± 12.5 % to 70.8 ± 20.3 %, p < 0.001). Mean shortening in QRS duration was 31.3 ms (from 165.1 ± 16.3 to 133.8 ± 12.7, p < 0.001) and B-type natriuretic peptide (in picograms per milliliter) dropped from 834 ± 350 to 621 ± 283 (p < 0.001). Ejection fraction (in percent) increased from 27.5 ± 4.6 to 33.3 ± 4.4 (p < 0.001), and mitral regurgitation severity decreased by one grade (from 2.7 ± 0.9 to 1.8 ± 0.7, p < 0.05). CONCLUSION RV bifocal pacing seems to offer a substantial clinical benefit to heart failure patients with traditional CRT indications and could be an alternative option when LV access is unsuccessful.
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Affiliation(s)
- Skevos Sideris
- Cardiology Department, Hippokration Hospital, Athens, Greece
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Burri H, Domenichini G, Sunthorn H, Ganiere V, Stettler C. Comparison of tools and techniques for implanting pacemaker leads on the ventricular mid-septum. Europace 2011; 14:847-52. [DOI: 10.1093/europace/eur404] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kronborg MB, Poulsen SH, Mortensen PT, Nielsen JC. Left ventricular performance during para-His pacing in patients with high-grade atrioventricular block: an acute study. Europace 2011; 14:841-6. [PMID: 22170898 DOI: 10.1093/europace/eur368] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To compare changes in left ventricular (LV) performance and mechanical synchrony between atrial-based pacing with intrinsic conduction (AAI), dual-chamber para-His Pacing (DDD-PHP) and dual-chamber right ventricular septal pacing (DDD-RVS) in patients with high-grade atrioventricular block (AVB). METHODS AND RESULTS Patients with high-grade AVB and QRS <120 ms, who had temporary intrinsic atrioventricular (AV) conduction the day after the implantation were included in the study. All patients received a biventricular pacemaker with a para-His lead in the LV port, and a RVS lead in the right ventricular port. Left ventricular three-dimensional echocardiograms, LV outlet tract-velocity time integrals (LVOT-VTI), and LV synchrony with tissue Doppler imaging were recorded during AAI, DDD-PHP, and DDD-RVS. Eleven patients were included. The mean LVOT-VTI was significant lower during DDD-RVS (19.2 ± 5.5 cm) as compared with DDD-PHP (21.4 ± 5.5 cm), P = 0.006 and AAI (21.6 ± 6.8 cm), P = 0.016. The LVEF was higher during AAI than during DDD-PHP (P= 0.02) and DDD-RVS (P< 0.01). The maximal time to peak velocity between basal segments was significant longer with DDD-RVS (95 ± 26 ms) than with AAI (72 ± 30 ms), P = 0.028, whereas no difference was observed between AAI and DDD-PHP (81 ± 42 ms), P = 0.20. CONCLUSIONS Acutely, DDD-PHP preserves LV systolic performance and mechanical synchrony as compared with DDD-RVS.
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Affiliation(s)
- Mads Brix Kronborg
- Department of Cardiology, Aarhus University Hospital, Skejby, Bendstrupgaardsvej 100, DK-8200 Aarhus N, Denmark.
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Hillock RJ, Mond HG. Pacing the right ventricular outflow tract septum: time to embrace the future. Europace 2011; 14:28-35. [PMID: 21846639 DOI: 10.1093/europace/eur251] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Transvenous pacing has revolutionized the management of patients with potentially life-threatening bradycardias and at its most basic level ensures rate support to maintain cardiac output. However, we have known for at least a decade that pacing from the right ventricle (RV) apex can induce left ventricle (LV) dysfunction, atrial fibrillation, heart failure, and maybe an increased mortality. Although pacemaker manufacturers have developed successful pacing algorithms designed to minimize unnecessary ventricular pacing, it cannot be avoided in a substantial proportion of pacemaker-dependent patients. Just as there is undoubted evidence that RV apical pacing is injurious, there is emerging evidence that pacing from the RV septum is associated with a shorter duration of activation, improved haemodynamics, and less LV remodelling. The move from traditional RV apical pacing to RV septal pacing requires a change in mindset for many practitioners. The anatomical landmarks and electrocardiograph features of RV septal pacing are well described and easily recognized. While active fixation is required to place the lead on the septum, shaped stylets are now available to assist the implanter. In addition, concerns about the stability and longevity of steroid-eluting active fixation leads have proven to be unfounded. We therefore encourage all implanters to adopt RV septal pacing to minimize the potential of harm to their patients.
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Affiliation(s)
- Richard J Hillock
- Department of Cardiology, The Royal Adelaide Hospital, Adelaide, Australia
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Ronn F, Kesek M, Karp K, Henein M, Jensen SM. Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation. Europace 2011; 13:1747-52. [DOI: 10.1093/europace/eur193] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Right ventricular septal pacing. COR ET VASA 2011. [DOI: 10.33678/cor.2011.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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; 23:1177-82. [DOI: 10.1016/j.echo.2010.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2009] [Indexed: 11/28/2022]
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Balt JC, van Hemel NM, Wellens HJJ, de Voogt WG. Radiological and electrocardiographic characterization of right ventricular outflow tract pacing. Europace 2010; 12:1739-44. [DOI: 10.1093/europace/euq341] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Verma AJ, Lemler MS, Zeltser IJ, Scott WA. Relation of right ventricular pacing site to left ventricular mechanical synchrony. Am J Cardiol 2010; 106:806-9. [PMID: 20816121 DOI: 10.1016/j.amjcard.2010.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Revised: 05/03/2010] [Accepted: 05/03/2010] [Indexed: 10/19/2022]
Abstract
Transvenous pacing leads are regularly placed in the right ventricular (RV) apex. Pediatric patients can develop myopathic changes after long-term RV apical pacing. Left ventricular (LV) mechanical dyssynchrony, estimated with echocardiography, may explain the acute decrease in LV function and long-term histopathologic changes. Ts-4w is an established echocardiographic measurement of LV synchrony, using tissue Doppler imaging (TDI). The purpose of this study was to determine whether TDI could identify acute changes in LV synchrony during pacing from different RV sites. We prospectively measured Ts-4w and Doppler-derived cardiac output after 5 minutes of pacing in 19 subjects undergoing catheter ablation. Each subject underwent pacing at 4 sites in random order: high right atrium, high RV septum (septal), RV outflow tract, and RV apex. Ts-4w was measured during sinus rhythm and each pacing protocol, with a value >65 ms defining mechanical dyssynchrony. Ts-4w during high right atrial (32.6 +/- 17.6 ms) and septal (28.9 +/- 10.9 ms) pacing were not different from sinus rhythm (39.5 +/- 15.5 ms). RV apex (85.7 +/- 18.4 ms) and RV outflow tract (84.2 +/- 20.4 ms) pacing induced mechanical dyssynchrony (p <0.0001). In conclusion, TDI demonstrated significant differences in LV synchrony related to pacing site. Ts-4w may be useful to determine ideal lead placement because it correlates with acutely improved hemodynamics.
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MOND HARRYG, VLAY STEPHENC. Pacing the Right Ventricular Septum: Time to Abandon Apical Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1293-7. [DOI: 10.1111/j.1540-8159.2010.02876.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Yue-Chun L, Li-Sha G, Xue-Qiang G, Peng C, Lian-Pin W, Peng-Lin Y, Ji-Fei T, Jia-Feng L. Establishment of a canine model of cardiac memory using endocardial pacing via internal jugular vein. BMC Cardiovasc Disord 2010; 10:30. [PMID: 20569432 PMCID: PMC2906410 DOI: 10.1186/1471-2261-10-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Accepted: 06/22/2010] [Indexed: 11/20/2022] Open
Abstract
Background Development of experimental animal models has played an important role in understanding the mechanisms of cardiac memory. The purpose of this study was to evaluate a new canine model of cardiac memory using endocardial ventricular pacing via internal jugular vein. Methods Twelve Beagle dogs underwent placement of a permanent ventricular pacemaker mimicking the use of pacemakers in humans and induction of cardiac memory by endocardial ventricular pacing. Results Cardiac memory was achieved in 11 of 12 attempts overall. Procedural mortality due to cardiac tamponade (n = 1) occurred in the first attempt. The T-wave memory persisted for 96 ± 17 minutes and 31 ± 6 days in the short-term and long-term cardiac memory groups, respectively. There were no significant differences in the heart rate, blood pressure and echocardiographic parameters in the animals between before and after ventricular pacing in the short-term and long-term cardiac memory groups. No significant pathologic changes with the light microscopy were found in the present study in all dogs. Conclusion The model does require surgery but is not as invasive as an open-chest model. This canine model can serve as a useful tool for studying mechanisms of cardiac memory.
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Affiliation(s)
- Li Yue-Chun
- Department of Cardiology, Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, Zhejiang 325000, China.
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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; 105:1426-32. [PMID: 20451689 DOI: 10.1016/j.amjcard.2010.01.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 12/27/2022]
Abstract
Chronic right ventricular apical pacing (RVAP) has been associated with negative hemodynamic and clinical effects. The aim of the present study was to compare RVAP with right ventricular septal pacing (RVSP) in terms of echocardiographic features and clinical outcomes. A total of 93 patients without structural heart disease and with an indication for a permanent pacemaker were randomly assigned to receive a screw-in lead either in the RV apex (n = 46) or in the RV mid-septum (n = 47). The patients were divided into 3 subgroups according to the percentage of ventricular pacing: control group (n = 21, percentage of ventricular pacing < or =10%), RVAP group (n = 28), or RVSP group (n = 32; both latter groups had a percentage of ventricular pacing >10%). The RVAP group had more intraventricular dyssynchrony and a trend toward a worse left ventricular ejection fraction compared to the RVSP and control groups at 12 months of follow-up (maximal delay to peak systolic velocity between any of the 6 left ventricular basal segments was 57.8 +/- 38.2, 35.5 +/- 20.6, and 36.5 +/- 17.8 ms for RVAP, RVSP, and control group, respectively; p = 0.006; mean left ventricular ejection fraction 62.9 +/- 7.9%, 66.5 +/- 7.2%, and 66.6 +/- 7.2%, respectively, p = 0.14). Up to 48.1% of the RVAP patients showed significant intraventricular dyssynchrony compared to 19.4% of the RVSP patients and 23.8% of the controls (p = 0.04). However, no overt clinical benefits from RVSP were found. In conclusion, RVAP was associated with increased dyssynchrony compared to the RVSP and control patients. RVSP could represent an alternative pacing site in selected patients to reduce the harmful effects of traditional RVAP.
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MOND HARRYG. The Road to Right Ventricular Septal Pacing: Techniques and Tools. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:888-98. [DOI: 10.1111/j.1540-8159.2010.02777.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Inoue K, Okayama H, Nishimura K, Ogimoto A, Ohtsuka T, Saito M, Hiasa G, Yoshii T, Sumimoto T, Funada J, Higaki J. Right Ventricular Pacing from the Septum Avoids the Acute Exacerbation in Left Ventricular Dyssynchrony and Torsional Behavior Seen with Pacing from the Apex. J Am Soc Echocardiogr 2010; 23:195-200. [DOI: 10.1016/j.echo.2009.10.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2009] [Indexed: 11/17/2022]
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Pachón Mateos JC, Pachón Mateos EI, Pachón Mateos JC. Right ventricular apical pacing: the unwanted model of cardiac stimulation? Expert Rev Cardiovasc Ther 2009; 7:789-99. [PMID: 19589115 DOI: 10.1586/erc.09.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite having a huge benefit in enabling heart rate control, cardiac pacing by stimulating the right ventricular apex causes an artificial iatrogenic left bundle-branch block-like syndrome. As a result, QRS widening and cardiac wall desynchronization occurs. The problems caused by this undesirable pacemaker side effect have been ignored, as they are counteracted by the great benefit of cardiac rate correction. However, the compelling evidence about its harmful effect presented in this article cannot be disregarded and should start an attitude change toward alternate sites of ventricular pacing and preclusion of the right ventricular apex stimulation.
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Affiliation(s)
- José Carlos Pachón Mateos
- Sao Paulo Heart Hospital Electrophysiology and Arrhythmia Service, Pacemaker Service of the Sao Paulo Cardiology Institute, Pacemaker Brazilian Registry, Brazil
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Madershahian N, Liakopoulos OJ, Wittwer T, Wippermann J, Kuhn-Regnier F, Naraghi H, Wahlers T. Temporary epicardial ventricular stimulation in patients with atrial fibrillation: acute effects of ventricular pacing site on bypass graft flows. J Card Surg 2009; 24:424-8. [PMID: 19583610 DOI: 10.1111/j.1540-8191.2008.00786.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Data on coronary artery bypass grafts flows in patients with atrial fibrillation (AF) requiring epicardial ventricular pacing is lacking. This study aimed to evaluate the optimal epicardial ventricular pacing site in patients with AF following coronary artery bypass surgery (CABG). METHODS In 23 consecutive patients (mean age = 69.2 +/- 1.9 years, gender = 62% male, ejection fraction [EF]= 50.4 +/- 2.1%) monoventricular stimulations (VVI) were tested with a constant pacing rate of 100 bpm. The impact of ventricular pacing on bypass graft flow (transit-time flow probe) and pulsatility index (PI) were measured after lead placement on the mid paraseptal region of the right (RVPS) and the left (LVPS) ventricle, on the right inferior wall (RVIW), and on the right ventricular outflow tract (RVOT). In addition, hemodynamic parameters were measured. Patients served as their own control. RESULTS Comparison of all tested pacing locations revealed that RVOT stimulation provided the highest bypass grafts flows (59.9 +/- 6.1 mL/min) and PI (2.2 +/- 0.1) when compared with RVPS (51.3 +/- 4.7 mL/min, PI = 2.6 +/- 0.2), RVIW (54.0 +/- 5.1 mL/m; PI = 2.4 +/- 0.2), and LVPS (53.1 +/- 4.5 mL/min; PI = 2.3 +/- 0.1), respectively (p < 0.05). When analyzing patients according to their preoperative LV function (group I = EF > 50%; group II = EF < 50%), higher bypass graft flows were observed with RVOT pacing in patients with lower EF (p = n.s.). CONCLUSIONS Temporary RVOT pacing facilitates optimal bypass graft flows when compared with other ventricular pacing sites and should be the preferred method of temporary pacing in cardiac surgery patients with AF. Especially in patients with low EF following CABG, RVOT pacing may improve myocardial oxygen conditions for the ischemic myocardium and enhance graft patency in the early postoperative period.
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Affiliation(s)
- Navid Madershahian
- Department of Cardiothoracic Surgery, Cologne University Heart Centre, Kerpener Strasse 62, Cologne, Germany.
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McGAVIGAN ANDREWD. Right Ventricular Septal Pacing-Can We See the Wood for the Trees? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:423-5. [DOI: 10.1111/j.1540-8159.2009.02300.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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MEDI CAROLINE, MOND HARRYG. Right Ventricular Outflow Tract Septal Pacing: Long-Term Follow-Up of Ventricular Lead Performance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:172-6. [DOI: 10.1111/j.1540-8159.2008.02199.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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BECKER GIULIANO, STURMER MARCIOL, PALISAITIS DONALD, ESSEBAG VIDAL. Right Ventricular Septal Lead Implantation: New Site, New Risks? J Cardiovasc Electrophysiol 2008; 19:754-5. [DOI: 10.1111/j.1540-8167.2007.01060.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Manolis AS, Sakellariou D, Andrikopoulos GK. Alternate Site Pacing in Patients at Risk for Heart Failure. Angiology 2008; 59:97S-102S. [DOI: 10.1177/0003319708321479] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac pacing from the right ventricular apex is the most common site of cardiac pacing. During the last decade, several studies demonstrated the harmful effects of the iatrogenic left bundle branch block, which is observed in cardiac pacing from the right ven- tricular apex. These observations led to an interest in alternative right ventricular pacing sites aiming to achieve a more “physiological” pattern of ventricular activation. Alternate site pacing may involve His bun- dle, other right ventricular sites (outflow or septal sites), or left ventricular sites in either unifocal or bifo- cal or biventricular modes. Pacing from the right ven- tricular outflow tract has been studied extensively. Several studies showed that right ventricular outflow tract pacing has better hemodynamic effects and less harmful influence. Bifocal right ventricular (apical and outflow tract) pacing has been proposed for patients with heart failure where the coronary sinus approach to effect biventricular pacing turns out to be unsuccessful because of various reasons. Some studies examined left ventricular pacing alone as an alternative mode of pacing, and the results were quite encouraging but not conclusive. Finally, in heart failure patients not responding to biventricular pacing, the triple site pacing mode has been recently proposed. In triple site pacing, the leads are inserted in the right ventricular apex and outflow tract in conjunction with lateral left ventricular pacing. Improvement of exercise capacity and increased ejection fraction were observed with this triventricular pacing. Although more data from specifically designed randomized studies are needed, there are many alternative pacing sites, especially for patients at high risk of heart failure, which seems to be less harmful and better tolerated by the patients.
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Affiliation(s)
- Antonis S. Manolis
- First Department of Cardiology, Evagelismos General
Hospital of Athens, Athens, Greece,
| | - Dimitrios Sakellariou
- First Department of Cardiology, Evagelismos General
Hospital of Athens, Athens, Greece
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Vanerio G, Vidal JL, Fernández Banizi P, Banina Aguerre D, Viana P, Tejada J. Medium- and long-term survival after pacemaker implant: Improved survival with right ventricular outflow tract pacing. J Interv Card Electrophysiol 2008; 21:195-201. [DOI: 10.1007/s10840-008-9238-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Accepted: 01/29/2008] [Indexed: 11/29/2022]
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Hillock RJ, Stevenson IH, Mond HG. The Right Ventricular Outflow Tract: A Comparative Study of Septal, Anterior Wall, and Free Wall Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:942-7. [PMID: 17669075 DOI: 10.1111/j.1540-8159.2007.00790.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is marked heterogeneity in right ventricular outflow tract (RVOT) pacemaker lead placement using conventional leads. As a result, we have sought to identify a reproducible way of placing a ventricular lead onto the RVOT septum. METHODS AND RESULTS A major determinant is the shape of the stylet used to deliver the active-fixation lead. We compared stylet shapes and configurations in patients who initially had a ventricular lead placed onto the anterior or free wall of the RVOT and then had the lead repositioned onto the septum. All leads were loaded with a stylet fashioned with a distal primary curve to facilitate delivery of the lead to the pulmonary artery, then using a pullback technique the lead was retracted to the RVOT. All lead placements were confirmed by fluoroscopy and electrocardiography. Anterior or free wall placement was achieved by the stylet having either the standard curve or an added distal anterior angulation. In contrast, septal lead positioning was uniformly achieved by a distal posterior angulation of the curved stylet. This difference in tip shape was highly predictive for septal placement (P < 0.001). With septal pacing, a narrower QRS duration was noted, compared to anterior or free wall pacing (136 vs 155 ms, P < 0.001). All pacing parameters were within acceptable limits. CONCLUSION Using appropriately shaped stylets, pacing leads can now be placed into specific positions within the RVOT and in particular septal pacing can be reliably and reproducibly achieved. This is an important step in the standardization of lead placement in the RVOT.
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Affiliation(s)
- Richard J Hillock
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
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Mond HG, Hillock RJ, Stevenson IH, McGavigan AD. The Right Ventricular Outflow Tract: The Road to Septal Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:482-91. [PMID: 17437571 DOI: 10.1111/j.1540-8159.2007.00697.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pacing from the right ventricular apex is associated with long-term adverse effects on left ventricular function. This has fuelled interest in alternative pacing sites, especially the septal aspect of the right ventricular outflow tract (RVOT). However, it is a common perception that septal RVOT pacing is difficult to achieve. METHODS AND RESULTS In this article, we will review the anatomy of the RVOT and discuss the importance of standard radiographic views and the 12-lead electrocardiogram in aiding lead placement. We will also describe a method utilizing a novel stylet shape, whereby a conventional active-fixation, stylet-driven lead can be easily and reliably deployed onto the RVOT septum.
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Affiliation(s)
- Harry G Mond
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Australia.
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40
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Fisher JD, Gross JN. Is the Twist Hazardous to Your Health? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:453-4. [PMID: 17437565 DOI: 10.1111/j.1540-8159.2007.00738.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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