Right ventricular pacing: the best site is yet to be defined

摘要： <正>The right ventricular (RV) apex is the traditional site to provide stable and reliable chronic ventricular pacing. Interest in alternate site pacing has grown since RV apical pacing has been associated with increased mortality and morbidity compared to normal atrio-ventricular conduction.Alternate pacing sites include the RV septum and outflow tract. Chronic pacing from RV apex causes abnormal ventricular activation and results in asynchronous left ventricular (LV) contraction and relaxation. Subsequent left ventricular structural and mechanical remodeling occurs that might explain the increased mortality and morbidity. The search for alternate pacing sites started several decades ago. No large scale, randomized, double-blind clinical trial shows one pacing site to be superior to another. The heterogeneity of alternate pacing sites between studies contributes to an inconclusive picture. In a recent review, de Cock et al analyzed nine reports on over 227 patients. Three of nine studies favored RV outflow tract pacing; six did not. ... （共2頁）