The Ideal Pacemaker for Complete AV Block

  • I. Eli Ovsyshcher
Conference paper


Since the initial description of the use of a transvenous endocardial lead for pacing in humans, in 1959 [1], the right ventricular apex (RVA) has served as the traditional site for lead positioning. However, RVA pacing produces an abnormal pattern of ventricular depolarization and there is growing evidence that pacing from this site is associated with adverse functional and structural changes in the left ventricle. This is manifested clinically in the deterioration of left ventricular (LV) function and increased morbidity and mortality. The results of numerous studies have described these observations, which were summarized in a recent review [2].


Ventricular Pace Left Ventricular Dyssynchrony Left Ventricular Free Wall Left Ventricular Pace Right Ventricular Apex 
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  1. 1.
    Furman S, Schwedel JB (1959) An intracardiac pacemaker for Stokes-Adams Seizures. N Engl J Med 261:943–948PubMedCrossRefGoogle Scholar
  2. 2.
    Sweeney MO, Prinzen FW (2006) A New Paradigm for Physiologic Ventricular Pacing. J Am Coll Cardiol 47:282–288PubMedCrossRefGoogle Scholar
  3. 3.
    Lieberman R, Padeletti L, Schreuder J et al (2006) Ventricular pacing lead location alters systemic hemodynamics and left ventricular function in patients with and without reduced ejection fraction. J Am Coll Cardiol 48:1634–1641PubMedCrossRefGoogle Scholar
  4. 4.
    Stellbrink C, Breithardt OA, Franke A et al (2001) Impact of cardiac resynchronization therapy using hemodynamically optimized pacing on left ventricular remodeling in patients with congestive heart failure and ventricular conduction disturbances. J Am Coll Cardiol 38:1957–1965PubMedCrossRefGoogle Scholar
  5. 5.
    Occhetta E, Bortnik M, Magnani A et al (2006) Prevention of ventricular desynchronization by permanent para-Hisian pacing after atrioventricular node ablation in chronic atrial fibrillation: a crossover, blinded, randomized study versus apical right ventricular pacing. J Am Coll Cardiol 47:1938–1945PubMedCrossRefGoogle Scholar
  6. 6.
    Laske TG, Skadsberg ND, Hill AJ et al (2006) Excitation of the intrinsic conduction system through His and interventricular septal pacing. Pacing Clin Electrophysiol 29:397–405PubMedCrossRefGoogle Scholar
  7. 7.
    Lewicka-Nowak E, Dabrowska-Kugacka A, Tybura S et al (2006) Right ventricular apex versus right ventricular outflow tract pacing: prospective, randomized, longterm clinical and echocardiographic evaluation. Kardiologia Polska 64:1082–1090PubMedGoogle Scholar
  8. 8.
    McGavigan AD, Mond HG (2006) Selective site ventricular pacing. Curr Opin Cardiol 21:7–14PubMedCrossRefGoogle Scholar
  9. 9.
    Sweeney MO, Hellkamp AS (2005) Baseline and post-implant risk scores for predicting heart failure hospitalization during pacemaker therapy for sinus node dysfunction. Heart Rhythm 2(Suppl 2):75–76CrossRefGoogle Scholar
  10. 10.
    Lupi G, Sassone B, Badano L et al; Ablate and Pace in Atrial Fibrillation (APAF) Pilot Echocardiographic Trial Investigators (2006) Effects of right ventricular pacing on intra-left ventricular electromechanical activation in patients with native narrow QRS. Am J Cardiol 98:219–222PubMedCrossRefGoogle Scholar
  11. 11.
    Hayes JJ, Sharma AD, Love JC et al (2006) Abnormal conduction increases risk of adverse outcomes from right ventricular pacing. J Am Coll Cardiol 48:1628–1633PubMedCrossRefGoogle Scholar
  12. 12.
    Kindermann M, Hennen B, Jung J et al (2006) Biventricular versus conventional right ventricular stimulation for patients with standard pacing indication and left ventricular dysfunction: the Homburg Biventricular Pacing Evaluation (HOBIPACE). J Am Coll Cardiol 47:1927–1937PubMedCrossRefGoogle Scholar
  13. 13.
    Leclercq C, Walker S, Linde C et al (2002). Comparative effects of permanent biventricular and right-univentricular pacing in heart failure patients with chronic atrial fibrillation. Eur Heart J 23:1780–1787PubMedCrossRefGoogle Scholar
  14. 14.
    Brignole M, Gammage M, Puggioni E et al (2005) Comparative assessment of right, left, and biventricular pacing in patients with permanent atrial fibrillation. Eur Heart J 26:712–722PubMedCrossRefGoogle Scholar
  15. 15.
    Doshi RN, Daoud EG, Fellows C et al (2005) Left ventricular-based cardiac stimulation post AV nodal ablation evaluation (the PAVE study). J Cardiovasc Electrophysiol 6:1160–1165CrossRefGoogle Scholar
  16. 16.
    Wyman BT, Hunter WC, Prinzen FW et al (2002) Effects of single-and biventricular pacing on temporal and spatial dynamics of ventricular contraction. Am J Physiol 282:H372–H379Google Scholar
  17. 17.
    O’Keefe JH Jr, Abuissa H, Jones PG et al (2005) Effect of chronic right ventricular apical pacing on left ventricular function. Am J Cardiol 95:771–773PubMedCrossRefGoogle Scholar
  18. 18.
    Thackray SD, Witte KK, Nikitin NP et al (2003) The prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in a typical regional pacemaker population. Eur Heart J 24:1143–1152PubMedCrossRefGoogle Scholar
  19. 19.
    Ovsyshcher IE, Barold SS (2007) Should cardiac resynchronization be considered for the primary prevention of heart failure? In: Ritter P, Barold SS (eds) Devices for cardiac resynchronization. Technologic and clinical aspects. Springer (in press)Google Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • I. Eli Ovsyshcher
    • 1
  1. 1.Electrophysiology, Faculty of Health SciencesBen Gurion University of the NegevBeerShevaIsrael

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