Document Detail

Alternate site pacing in patients at risk for heart failure.
MedLine Citation:
PMID:  18632765     Owner:  NLM     Status:  MEDLINE    
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 ventricular 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 bifocal or biventricular modes. Pacing from the right ventricular 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.
Antonis S Manolis; Dimitrios Sakellariou; George K Andrikopoulos
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Publication Detail:
Type:  Journal Article; Review     Date:  2008-07-16
Journal Detail:
Title:  Angiology     Volume:  59     ISSN:  1940-1574     ISO Abbreviation:  Angiology     Publication Date:    2008 Apr-May
Date Detail:
Created Date:  2008-08-20     Completed Date:  2008-10-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0203706     Medline TA:  Angiology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  97S-102S     Citation Subset:  IM    
First Department of Cardiology, Evagelismos General Hospital of Athens, Athens, Greece.
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MeSH Terms
Bundle of His
Bundle-Branch Block / etiology
Cardiac Pacing, Artificial / adverse effects,  methods*
Electrodes, Implanted
Heart Failure / etiology,  prevention & control*
Heart Ventricles
Pacemaker, Artificial*
Risk Factors

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