Right Ventricular Outflow Tract Pacing: Not Ready for Prime-Time

Invited Commentary
cardiac pacing biventricular pacing alternative site pacing 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Nielsen JC, Kristensen L, Andersen HR, Mortensen PT, Perdersen OL, Pedersen AK. A randomized comparison of atrial and dual chamber pacing in 177 consecutive patients with sick sinus syndrome. Echocardiograhic and clinical outcome. J Am Coll Cardiol 2003:42:614–623.CrossRefPubMedGoogle Scholar
  2. 2.
    Wilkoff BL, Cook JR, Epstein AE, Green HL, Hallstrom AP, Hsia H, Kutalek SP, Sharma A. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002;288:3115–3123.CrossRefPubMedGoogle Scholar
  3. 3.
    Sweeney MO, Hellkamp AS, Ellenbogen KA, Greenspon AJ, Freedman RA, Lee KL, Lamas GA for the MOST Investigators. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003;107:2932–2937.Google Scholar
  4. 4.
    Moss AJ, Zareba W, Hall WJ, Klein H, Wilber DJ, Daubert JP, Cannom DS, Higgins SL, Brown MW, Andrews ML. Multicenter Automatic Defibrillator Implantation Trial II Investigators. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med 2002;346:877–883.CrossRefPubMedGoogle Scholar
  5. 5.
    Steinberg JS, Maniar P, Zareba W, et al., for the MADIT-II Investigators. The relationship between right ventricular pacing and outcomes in MADIT-II patients. Program and abstracts from the North American Society of Pacing and Electrophysiology Annual Scientific Sessions; May 14–17, 2003; Washington, DC.Google Scholar
  6. 6.
    Barold SS. Adverse effects of ventricular desynchronization induced by long-term right ventricular pacing. J Am Coll Cardiol 2003;42:624–626.CrossRefPubMedGoogle Scholar
  7. 7.
    Tantengo MV, Thomas RL, Karpawich PP. Left ventricular dysfunction after long-term right ventricular pacing in the young. J Am Coll Cardiol 2001;37:2093–2100.CrossRefPubMedGoogle Scholar
  8. 8.
    Thambo JB, Bordachar P, Garrigue S, Lafitte S, Sanders P, Reuter S, Girardot R, Crepin D, Reant P, Roudaut R, Jais P, Haissaguerre M, Clementy J, Jimenez M. Detrimental ventricular remodeling in patients with congenital complete heart block and chronic right ventricular apical pacing. Circulation 2004 Dec. 6; [Epub ahead of print]Google Scholar
  9. 9.
    Udink ten Cate FE, Breur JM, Cohen MI, Boramanand N, Kapusta L, Crosson JE, Brenner JI, Lubbers LJ, Friedman AH, Vetter VL, Meijboom EJ. Dilated cardiomyopathy in isolated congenital complete atrioventricular block: Early and long-term risk in children. J Am Coll Cardiol 2001;37:1129–1134.CrossRefPubMedGoogle Scholar
  10. 10.
    Moak JP, Barron KS, Hougen TJ, Wiles HB, Balaji S, Sreeram N, Cohen MH, Nordenberg A, Van Hare GF, Friedman RA, Perez M, Cecchin F, Schneider DS, Nehgme RA, Buyon JP. Congenital heart block: Development of late-onset cardiomyopathy, a previously underappreciated sequela. J Am Coll Cardiol 2001;37:238–242.CrossRefPubMedGoogle Scholar
  11. 11.
    van Oosterhout MF, Prinzen FW, Arts T, Scheuder JJ, Vanagt WY, Cleutjens JP, Reneman RS. Asynchronous electrical activation induces asymmetrical hypertrophy of the left ventricular wall. Circulation 1998;98:588–595.PubMedGoogle Scholar
  12. 12.
    Karpawich PP, Justice CD, Cavitt DK, Chang CH. Developmental sequelae of fixed rate ventricular pacing in the immature canine heart: An electrophysiologic, hemodynamic and histopathologic evaluation. Am Heart J 1990;119:1077–1083.PubMedGoogle Scholar
  13. 13.
    Adomian G, Beazell J. Myofibrillar disarray produced in normal hearts by chronic electrical pacing. Am Heart J 1986;112:79–83.CrossRefPubMedGoogle Scholar
  14. 14.
    Prinzen FW, Peschar M. Relation between the pacing-induced sequence of activation and left ventricular pump function in animals. Pacing Clin Electrophysiol 2002;25:484–498.CrossRefPubMedGoogle Scholar
  15. 15.
    Spragg DD, Leclercq C, Loghmani M, Faris OP, Tunin RS, DiSilvertre D, McVeigh ER, Tomaselli GF, Kass DA. Regional alterations in protein expression in the dyssynchronous failing heart. Circulation 2003;108:929–932.CrossRefPubMedGoogle Scholar
  16. 16.
    de Cock CC, Giudici MC, Twisk JW. Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review. Europace 2003;5:275–278.CrossRefPubMedGoogle Scholar
  17. 17.
    Tse HF, Yu C, Wong KK, Tsang V, Leung YL, Ho WY, Lau CP. Functional abnormalities in patients with permanent right ventricular pacing: The effect of sites of electrical stimulation. J Am Coll Cardiol 2002;40:1451–1458.CrossRefPubMedGoogle Scholar
  18. 18.
    Peschar M, Marsh AM, Verbeek XAAM, Prinzen FW, Gammage MD. Site of right ventricular pacing in patients with atrioventricular block. Heart Rhythm 2004;1 (Issue 1S):S245.Google Scholar
  19. 19.
    Bourke JP, Hawkins T, Keavey P, Tynan M, Jamieson S, Behulova R, Furniss SS. Evolution of ventricular function during permanent pacing from either right ventricular apex or outflow tract following AV junctional ablation for atrial fibrillation. Europace 2002;4:219–228.CrossRefPubMedGoogle Scholar
  20. 20.
    Victor F, Leclercq C, Mabo P, Pavin D, Deviller A, dePlace C, Pezard P, Victor J, Daubert C. Optimal right ventricular pacing site in chronically implanted patients: A prospective randomized crossover comparison of apical and outflow tract pacing. J Am Coll Cardiol 1999;33:311–316.CrossRefPubMedGoogle Scholar
  21. 21.
    Mera F, DeLurgio DB, Patterson RE, Merlino JD, Wade ME, Leon AR. A comparison of ventricular function during high right ventricular septal and apical pacing after his-bundle ablation for refractory atrial fibrillation. Pacing Clin Elecctrophysiol 1999;2:1234–1239.Google Scholar
  22. 22.
    Stambler BS, Ellenbogen K, Zhang X, Porter TR, Xie F, Malik R, Small R, Burke M, Kaplan A, Nair L, Belz M, Fuenzalida C, Gold M, Love C, Sharma A, Silverman R, Sogade F, Van Natta B, Wilkoff BL; ROVA Investigators. Right ventricular outflow versus apical pacing in pacemaker patients with congestive heart failure and atrial fibrillation. J Cardiovasc Electrophysiol 2003;14:1180–1186.CrossRefPubMedGoogle Scholar
  23. 23.
    Victor F, Mansour H, Pavin D, DePlace C, Crocq C, Mabo P, Daubert JC. Optimal right ventricular pacing site in classical pacemaker indications: A randomized crossover comparison of apical and septal pacing (Abstract). Heart Rhythm 2004;1(Issue 12S):S70–71.CrossRefGoogle Scholar
  24. 24.
    Muto C, Sacra C, Carreras G, Canciello M, Ascione L, Accadia M, Rumolo S, Tartaglia F, Irace L, Minicucci F, Scotto G, Maresca G, Bernadino T. Effects of pacing the right ventricular outflow tract in patients with chronic atrial fibrillation and low ejection fraction (Abstract). Europace 2004;6(Suppl 1):157.Google Scholar
  25. 25.
    Manzano JUJ, Balanos J, Cabrera E. Right ventricular outflow pacing: Assessment by an implantable hemodynamic sensor (Abstract). Europace 2004;6(Suppl 1):127.Google Scholar
  26. 26.
    Lewicka-Nowak E, Dabrowska-Kugacka A, Tybura S, Wilczek R, Staniewicz J, Gawrysiak M, Swiatecka G. Right apical and right outflow tract pacing; long-term echocardiographic comparison (Abstract). Giornale Italiano di Aritmologia e Cardiostimolazione 2004;7(Deember):1–2.Google Scholar
  27. 27.
    Frohlig G, Schwaab B, Kindermann M. Selective site pacing: The right ventricular approach. Pacing Clin Electrophysiol 2004;27:855–861.CrossRefPubMedGoogle Scholar
  28. 28.
    Gammage MD, Marsh AM. Randomized trials for selective site pacing: Do we know where we are going? Pacing Clin Electrophysiol 2004;27:878–882.CrossRefPubMedGoogle Scholar
  29. 29.
    Riedlbauchova L, Kautzner J, Hatala R, Buckingham TA. Is right ventricular outflow tract pacing an alternative to left ventricular/biventricular pacing? Pacing Clin Electrophysiol 2004;27:871–877.CrossRefPubMedGoogle Scholar
  30. 30.
    Vlay SC. Alternatives when coronary sinus pacing is not possible. Pacing Clin Electrophysiol 2003;26:4–7.CrossRefPubMedGoogle Scholar
  31. 31.
    Vlay SC. Alternate site biventricular pacing: Bi-V in the RV—is there a role? Pacing Clin Electrophysiol 2004;27:567–569.CrossRefPubMedGoogle Scholar
  32. 32.
    da Silva Menezes A. Outcome of right ventricular bifocal pacing in patients with permanent atrial fibrillation and severe dilated cardiomiopathy due to chagas disease: Three years of follow-up. J Interv Card Electrophysiol 2004;11:193–198.CrossRefPubMedGoogle Scholar
  33. 33.
    Menezes A Jr, Moreira HG, Daher MT. Outcome of right ventricular bifocal pacing in patients with permanent atrial fibrillation and severe dilated cardiomyopathy due to Chagas disease; three years of follow-up (Abstract). Europace 2004;6(Suppl 1):32.CrossRefPubMedGoogle Scholar
  34. 34.
    Donell DO, Nadurata V, Hamer A, Mohammed W. Dual site right ventricular pacing as an alternative to biventricular pacing (Abstract). Europace 2004;6(Suppl 1):194.Google Scholar
  35. 35.
    Alonso C, Goscinska K, Ritter P, Jauvert G, Lazarus A, Cazeau S. Upgrading to triple-ventricular pacing guided by clinical outcomes and echo assessment: A pilot study (Abstract). Europace 2004;6(Suppl 1):195.Google Scholar
  36. 36.
    Doshi R. PAVE Trial. Presented at the American College of Cardiology Annual Scientific Session, March 2004.Google Scholar
  37. 37.
    PAVE Trial: Biventricular pacing superior to RV pacing in atrial fibrillation patients treated with Ablate and Pace therapy http://www.medscape.com/viewarticle/471604.
  38. 38.
    Daoud E, Doshi R, Fellows C,Turk KT, Duran A, Hamdan MH, Pires L, and the Investigators of the PAVE Study. Ablate and pace with cardiac resynchronization therapy for patients with reduced ejection fraction; Sub-analysis of PAVE study. Heart Rhythm 2004;1(Suppl): S59.CrossRefGoogle Scholar
  39. 39.
    Kass DA. Pathophysiology of cardiac dyssynchrony and resynchronization. In: Ellenbogen KA, Kay GN, Wilkoff BL, eds., Device Therapy for Congestive Heart Failure, Philadelphia, PA, 2004:27–46.Google Scholar
  40. 40.
    Horwich T, Foster E, DE Marco T, Tseng Z, Saxon L. Effects of resynchronization therapy on cardiac function in pacemaker patients “upgraded” to biventricular devices. J Cardiovasc Electrophysiol 2004;15:1284–1289.CrossRefPubMedGoogle Scholar
  41. 41.
    Leon AR, Greenberg JM, Kanuru N, Baker CM, Mera FV, Smith AL, Langberg JJ, DeLurgio DB. Cardiac resynchronization in patients with congestive heart failure and chronic atrial fibrillation: Effect of upgrading to biventricular pacing after chronic right ventricular pacing. J Am Coll Cardiol 2002;39:1258–1263.CrossRefPubMedGoogle Scholar
  42. 42.
    Valls-Bertault V, Fatemi M, Gilard M, Pennec PY, Etienne Y, Blanc JJ. Assessment of upgrading to biventricular pacing in patients with right ventricular pacing and congestive heart failure after atrioventricular junctional ablation for chronic atrial fibrillation. Europace 2004; 6:438–443.CrossRefPubMedGoogle Scholar
  43. 43.
    Linde C, Leclercq C, Rex S, Garrigue S, Lavergne T, Cazeau S, McKenna W, Fitzgerald M, Deharo JC, Alonso C, Walker S, Braunschweig F, Bailleul C, Daubert JC. Long-term benefits of biventricular pacing in congestive heart failure: Results from the MUltisite STimulation in cardiomyopathy (MUSTIC) study. J Am Coll Cardiol 2002;40:111–118.CrossRefPubMedGoogle Scholar
  44. 44.
    Baker CM, Christopher TJ, Smith PF, Langberg JJ, Delurgio DB, Leon AR. Addition of a left ventricular lead to conventional pacing systems in patients with congestive heart failure: Feasibility, safety, and early results in 60 consecutive patients. Pacing Clin Electrophysiol 2002;25:1166–1171.CrossRefPubMedGoogle Scholar
  45. 45.
    Rosen BD, Berger R. resynchronization therapy upgrade. Turning coach into first class. J Cardiovasc Electrophysiol 2004;15:1290–1292.CrossRefPubMedGoogle Scholar
  46. 46.
    Thackray SD, Witte KK, Nikitin NP, Clark AL, Kaye GC, Cleland JG. The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population. Eur Heart J 2003;24:1143–1152.CrossRefPubMedGoogle Scholar
  47. 47.
    Sagar S, Jahangir A, Friedman PA, Cha Y, Rea RF, Cpburn PJ, Hayes DL. Long-term right ventricular apex pacing in patients with congenital AV block does not have a detrimental effect on ventricular function (Abstract). Circulation 2004;110(Suppl III):III-345–346.Google Scholar
  48. 48.
    Blanc JJ, Bertault-Valls V, Fatemi M, Gilard M, Pennec PY, Etienne Y. Midterm benefits of left univentricular pacing in patients with congestive heart failure. Circulation 2004;109:1741–1744.CrossRefPubMedGoogle Scholar
  49. 49.
    Stevenson WG, Sweeney MO. Single site left ventricular pacing for cardiac resynchronization. Circulation 2004;109:1694–1696.CrossRefPubMedGoogle Scholar
  50. 50.
    Deshmukh PM, Romanyshyn M. Direct His-bundle pacing: Present and future. Pacing Clin Electrophysiol 2004;27:862–870.CrossRefPubMedGoogle Scholar
  51. 51.
    Vanagt WY, Verbeek XA, Delhaas T, Mertens L, Daenen WJ, Prinzen FW. The left ventricular apex is the optimal site for pediatric pacing. Correlation with animal experiments. Pacing Clin Electrophysiol 2004;27:837–843.CrossRefPubMedGoogle Scholar
  52. 52.
    Karpawich PP. Chronic right ventricular pacing and cardiac performance: The pediatric perspective. Pacing Clin Electrophysiol 2004;27:844–849.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  1. 1.Tampa General Hospital and the University of South Florida College of MedicineTampaUSA
  2. 2.5806 Mariner’s Watch DriveTampaUSA

Personalised recommendations