2012 Mar 27. doi: 10.1111/j.1540-8159.2012.03371.x.
Publicado en: Pacing and clinical electrophysiology : PACE

Con la participación del Dr. Manlio F. Márquez, del Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez.

 

Publicación miembro SOMEEC: Adverse Effects of Long-Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure

 

ANTONIO DE S ISTI, M.D.,* MANLIO F. M ´ARQUEZ, M.D.,† JOELCI TONET, M.D. * AIM ´E BONNY, M.D., *,‡ ROBERT FRANK, M.D.,* and F RANC¸ OISE HIDDEN-LUCET, M.D. * From the *Cardiology Institute, R hythmology Unit, Piti ´e-Salp ˆetri `ere Hospital, Paris, France; †Electrophysiology Department, National I nstitute of Cardiology “Ignacio C h ´avez,” Mexico C ity, Mexico; and ‡Cardiology Unit, Saint Camille Hospital, Bry-sur-Marne, France

Abstract

In patients needing a pacemaker (PM) for bradycardia indications, the amount of right ventricular (RV) apical pacing has been correlated with atrial fibrillation (AFib) and heart failure (HF) in both DDD and VVI mode. RV pacing was linked with left ventricular (LV) dyssynchrony in almost 50% of patients with PM implantation and atrioventricular (AV) node ablation for AFib. In patients with normal systolic function needing a PM, apical RV pacing resulted in LV ejection fraction (LVEF) reduction. These negative effects were prevented by cardiac resynchronization therapy (CRT). Algorithms favoring physiological AV conduction are possible useful tools able to maintain both atrial and ventricular support and limit RV pacing. However, when chronic RV pacing cannot be avoided, it appears necessary to reconsider the cut-off value of basic LVEF for CRT. In HF patients, RV pacing can induce greater LV dyssynchrony, enhanced by underlying conduction diseases. In this context, a more deleterious effect of RV pacing in implantable cardioverter-defibrillator (ICD) patients with low LVEF can be expected. In some major ICD trials, DDD mode was correlated with increased mortality/HF. This negative impact was attributed to unnecessary RV pacing >40-50%, virtually absent in VVI-40 mode. However, some data suggest that avoiding RV pacing may also not be the best option for patients requiring an ICD. In patients with impaired LV function, AV synchrony should therefore be ensured. The best pacing mode in ICD patients with HF should be defined on an individual basis. (PACE 2012;1-8).

©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.

PMID: 22452247 [PubMed]