What Is the Optimal Site for Right Ventricular Pacing: Outflow Tract or Apex?

  • P. E. Vardas
  • E. N. Simantirakis
Conference paper


Although the first permanent transvenous pacing lead was implanted by Furman [1] in the right ventricular outflow tract, the site which came to be the standard for permanent cardiac pacing was the right ventricular apex. This site is easily accessible and ensures low sensing and pacing thresholds, while the chance of lead dislodgement is small. However, in cases where the activation of the ventricular myocardium occurs entirely through pacing — such as in complete atrioventricular block — the initiation of repolarisation from the right ventricular apex leads to desynchronisation of the contraction of the left ventricle and consequent haemodynamic disturbances, to disturbances of myocardial perfusion and innervation, and possibly to structural damage. Apart from the special case of patients with hypertrophic obstructive cardiomyopathy, where apical stimulation leads to a reduction in the obstruction of the left ventricular outflow tract and to an improvement in symptoms, in every other case electrical stimulation at the right ventricular apex is not best for the patient. Thus in recent years, as our understanding of the pathophysiology of the paced heartbeat has grown, new sites have been sought for the implantation of ventricular leads. Among these, the right ventricular outflow tract has been considered suitable, since access to it is relatively easy, it provides satisfactory sensing and pacing thresholds and, more importantly, it restores a more physiological activation sequence. However, there is conflict among the data in the available literature as regards the comparative evaluation of the two pacing sites, while other pacing sites or combinations of sites have been investigated both in patients with normal hearts and in those with heart failure.


Ventricular Outflow Tract Left Ventricular Outflow Tract Ventricular Pace Right Ventricular Outflow Tract Pace Site 
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Copyright information

© Springer-Verlag Italia 2000

Authors and Affiliations

  • P. E. Vardas
    • 1
  • E. N. Simantirakis
    • 1
  1. 1.Cardiology DepartmentHeraklion University HospitalCreteGreece

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