Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: a quantitative review

• Published in: Europace (London, England) Vol. 5; no. 3; pp. 275 - 278
• Main Authors: de Cock, C C, Giudici, M C, Twisk, J W
• Format: Journal Article
• Language: English
• Published: England 01-07-2003
• Subjects: Bradycardia - physiopathology; Bradycardia - therapy; Cardiac Pacing, Artificial - adverse effects; Heart Ventricles - physiopathology; Hemodynamics - physiology; Humans; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - physiopathology
• ISSN: 1099-5129
• DOI: 10.1016/S1099-5129(03)00031-X

The right ventricular apex has been used for cardiac stimulation because this position is easily accessible and is associated with a stable position of the electrode with a low dislodgement rate. This position, however, is associated with a dyssynchronous left ventricular contraction with subsequent deleterious haemodynamic effects. Alternative stimulation sites have been studied extensively because of a potentially better haemodynamic effect compared with right ventricular apex pacing. Using a Cochrane search strategy, nine studies were selected to analyze the haemodynamic effects of right ventricular outflow-tract pacing. The results of these studies (n=217) were pooled and indicated a significantly better haemodynamic effect (odds ratio 0.34, confidence interval 0.15-0.53) compared with right ventricular apex pacing. Therefore, these data suggest that right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.