Selective pacing sites

Pasquale Assennato, Salvatore Novo, Giuseppina Novo, Stefano Augugliaro, Egle Corrado, Carmelo La Greca, Laura Ajello, Angela Nogara, Giuseppe Coppola, Ciaramitaro, Pasquale Assennato, Egle Corrado, Stefano Augugliaro, Novo, Giuseppe Coppola, Ajello, La Greca, Nogara, Giuseppina Novo

Risultato della ricerca: Article

Abstract

The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All these long-term changes could account for the higher morbidity and mortality rates observe in patients with chronic RVA pacing compared with atrial pacing. This observation led to the reassessment of traditional approaches and to the research of alternative pacing sites, in order to get to more physiological pattern of ventricular activation and to avoid deleterious effects. Then, attempts were made with: right ventricular outflow tract (RVOT) pacing, direct His bundle pacing (DHBP), parahisian pacing (PHP) and bifocal (RVA + RVOT) pacing. For example, RVOT pacing, especially in its septal portion, is superior to the RVA pacing and it would determine a contraction pattern very similar to the spontaneous one, not only because the septal portions are the first parts to became depolarized, but also for the proximity to the normal conduction system. RVOT is preferable in terms of safety too. DHBP is an attractive alternative to RVA pacing because it leads to a synchronous depolarization of myocardial cells and, therefore, to an efficient ventricular contraction. So it would be the best technique, however the procedure requires longer average implant times and dedicated instruments and it cannot be carried out in patients affected by His bundle pathologies; furthermore, due to the His bundle fibrous area, higher pacing thresholds are required, causing accelerated battery depletion. For all these reasons, PHP could be considered an important alternative to DHBP, to be used on a large scale. Finally, bifocal pacing in CRT candidates, provides better acute hemodynamic performance than RVA pacing, derived from a minor intra-and interventricular dyssynchrony, expressed also by the QRS shortening. Then, bifocal pacing could be taken into account when RVA pacing is likely to be the origin of serious mechanical and electrical dyssynchrony or when CRT is contraindicated or technically impossible. So, whatever chosen as selective pacing site, you must look also at safety, effectiveness and necessary equipment for an optimal pacing site.
Lingua originaleEnglish
pagine (da-a)151-160
Numero di pagine10
RivistaMinerva Cardioangiologica
Volume63
Stato di pubblicazionePublished - 2015

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Bundle of His
Hemodynamics
Safety
Bundle-Branch Block
Left Ventricular Dysfunction
Left Ventricular Function
Heart Ventricles
Dilatation
Perfusion
Pathology
Morbidity
Equipment and Supplies
Mortality
Research

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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Selective pacing sites. / Assennato, Pasquale; Novo, Salvatore; Novo, Giuseppina; Augugliaro, Stefano; Corrado, Egle; La Greca, Carmelo; Ajello, Laura; Nogara, Angela; Coppola, Giuseppe; Ciaramitaro; Assennato, Pasquale; Corrado, Egle; Augugliaro, Stefano; Novo; Coppola, Giuseppe; Ajello; La Greca; Nogara; Novo, Giuseppina.

In: Minerva Cardioangiologica, Vol. 63, 2015, pag. 151-160.

Risultato della ricerca: Article

Assennato, P, Novo, S, Novo, G, Augugliaro, S, Corrado, E, La Greca, C, Ajello, L, Nogara, A, Coppola, G, Ciaramitaro, Assennato, P, Corrado, E, Augugliaro, S, Novo, Coppola, G, Ajello, La Greca, Nogara & Novo, G 2015, 'Selective pacing sites', Minerva Cardioangiologica, vol. 63, pagg. 151-160.
Assennato, Pasquale ; Novo, Salvatore ; Novo, Giuseppina ; Augugliaro, Stefano ; Corrado, Egle ; La Greca, Carmelo ; Ajello, Laura ; Nogara, Angela ; Coppola, Giuseppe ; Ciaramitaro ; Assennato, Pasquale ; Corrado, Egle ; Augugliaro, Stefano ; Novo ; Coppola, Giuseppe ; Ajello ; La Greca ; Nogara ; Novo, Giuseppina. / Selective pacing sites. In: Minerva Cardioangiologica. 2015 ; Vol. 63. pagg. 151-160.
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abstract = "The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All these long-term changes could account for the higher morbidity and mortality rates observe in patients with chronic RVA pacing compared with atrial pacing. This observation led to the reassessment of traditional approaches and to the research of alternative pacing sites, in order to get to more physiological pattern of ventricular activation and to avoid deleterious effects. Then, attempts were made with: right ventricular outflow tract (RVOT) pacing, direct His bundle pacing (DHBP), parahisian pacing (PHP) and bifocal (RVA + RVOT) pacing. For example, RVOT pacing, especially in its septal portion, is superior to the RVA pacing and it would determine a contraction pattern very similar to the spontaneous one, not only because the septal portions are the first parts to became depolarized, but also for the proximity to the normal conduction system. RVOT is preferable in terms of safety too. DHBP is an attractive alternative to RVA pacing because it leads to a synchronous depolarization of myocardial cells and, therefore, to an efficient ventricular contraction. So it would be the best technique, however the procedure requires longer average implant times and dedicated instruments and it cannot be carried out in patients affected by His bundle pathologies; furthermore, due to the His bundle fibrous area, higher pacing thresholds are required, causing accelerated battery depletion. For all these reasons, PHP could be considered an important alternative to DHBP, to be used on a large scale. Finally, bifocal pacing in CRT candidates, provides better acute hemodynamic performance than RVA pacing, derived from a minor intra-and interventricular dyssynchrony, expressed also by the QRS shortening. Then, bifocal pacing could be taken into account when RVA pacing is likely to be the origin of serious mechanical and electrical dyssynchrony or when CRT is contraindicated or technically impossible. So, whatever chosen as selective pacing site, you must look also at safety, effectiveness and necessary equipment for an optimal pacing site.",
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author = "Pasquale Assennato and Salvatore Novo and Giuseppina Novo and Stefano Augugliaro and Egle Corrado and {La Greca}, Carmelo and Laura Ajello and Angela Nogara and Giuseppe Coppola and Ciaramitaro and Pasquale Assennato and Egle Corrado and Stefano Augugliaro and Novo and Giuseppe Coppola and Ajello and {La Greca} and Nogara and Giuseppina Novo",
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T1 - Selective pacing sites

AU - Assennato, Pasquale

AU - Novo, Salvatore

AU - Novo, Giuseppina

AU - Augugliaro, Stefano

AU - Corrado, Egle

AU - La Greca, Carmelo

AU - Ajello, Laura

AU - Nogara, Angela

AU - Coppola, Giuseppe

AU - Ciaramitaro, null

AU - Assennato, Pasquale

AU - Corrado, Egle

AU - Augugliaro, Stefano

AU - Novo, null

AU - Coppola, Giuseppe

AU - Ajello, null

AU - La Greca, null

AU - Nogara, null

AU - Novo, Giuseppina

PY - 2015

Y1 - 2015

N2 - The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All these long-term changes could account for the higher morbidity and mortality rates observe in patients with chronic RVA pacing compared with atrial pacing. This observation led to the reassessment of traditional approaches and to the research of alternative pacing sites, in order to get to more physiological pattern of ventricular activation and to avoid deleterious effects. Then, attempts were made with: right ventricular outflow tract (RVOT) pacing, direct His bundle pacing (DHBP), parahisian pacing (PHP) and bifocal (RVA + RVOT) pacing. For example, RVOT pacing, especially in its septal portion, is superior to the RVA pacing and it would determine a contraction pattern very similar to the spontaneous one, not only because the septal portions are the first parts to became depolarized, but also for the proximity to the normal conduction system. RVOT is preferable in terms of safety too. DHBP is an attractive alternative to RVA pacing because it leads to a synchronous depolarization of myocardial cells and, therefore, to an efficient ventricular contraction. So it would be the best technique, however the procedure requires longer average implant times and dedicated instruments and it cannot be carried out in patients affected by His bundle pathologies; furthermore, due to the His bundle fibrous area, higher pacing thresholds are required, causing accelerated battery depletion. For all these reasons, PHP could be considered an important alternative to DHBP, to be used on a large scale. Finally, bifocal pacing in CRT candidates, provides better acute hemodynamic performance than RVA pacing, derived from a minor intra-and interventricular dyssynchrony, expressed also by the QRS shortening. Then, bifocal pacing could be taken into account when RVA pacing is likely to be the origin of serious mechanical and electrical dyssynchrony or when CRT is contraindicated or technically impossible. So, whatever chosen as selective pacing site, you must look also at safety, effectiveness and necessary equipment for an optimal pacing site.

AB - The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All these long-term changes could account for the higher morbidity and mortality rates observe in patients with chronic RVA pacing compared with atrial pacing. This observation led to the reassessment of traditional approaches and to the research of alternative pacing sites, in order to get to more physiological pattern of ventricular activation and to avoid deleterious effects. Then, attempts were made with: right ventricular outflow tract (RVOT) pacing, direct His bundle pacing (DHBP), parahisian pacing (PHP) and bifocal (RVA + RVOT) pacing. For example, RVOT pacing, especially in its septal portion, is superior to the RVA pacing and it would determine a contraction pattern very similar to the spontaneous one, not only because the septal portions are the first parts to became depolarized, but also for the proximity to the normal conduction system. RVOT is preferable in terms of safety too. DHBP is an attractive alternative to RVA pacing because it leads to a synchronous depolarization of myocardial cells and, therefore, to an efficient ventricular contraction. So it would be the best technique, however the procedure requires longer average implant times and dedicated instruments and it cannot be carried out in patients affected by His bundle pathologies; furthermore, due to the His bundle fibrous area, higher pacing thresholds are required, causing accelerated battery depletion. For all these reasons, PHP could be considered an important alternative to DHBP, to be used on a large scale. Finally, bifocal pacing in CRT candidates, provides better acute hemodynamic performance than RVA pacing, derived from a minor intra-and interventricular dyssynchrony, expressed also by the QRS shortening. Then, bifocal pacing could be taken into account when RVA pacing is likely to be the origin of serious mechanical and electrical dyssynchrony or when CRT is contraindicated or technically impossible. So, whatever chosen as selective pacing site, you must look also at safety, effectiveness and necessary equipment for an optimal pacing site.

KW - Artificial; Cardiac pacing; Heart failure; Heart ventricles; Cardiology and Cardiovascular Medicine

UR - http://hdl.handle.net/10447/176792

UR - http://www.minervamedica.it/en/journals/minerva-cardioangiologica/archive.php

M3 - Article

VL - 63

SP - 151

EP - 160

JO - Minerva Cardioangiologica

JF - Minerva Cardioangiologica

SN - 0026-4725

ER -