Author + information
- Received April 17, 2017
- Accepted May 3, 2017
- Published online June 19, 2017.
- aGeisinger Heart Institute, Wilkes-Barre, Pennsylvania
- bHôpital Cardiologique du Haut-Lêvêque CHU Bordeaux, Université Bordeaux, IHU LIRYC, Bordeaux, France
- cVirginia Commonwealth University Health System, Richmond, Virginia
- ↵∗Address for correspondence:
Dr. Pugazhendhi Vijayaraman, Cardiac Electrophysiology, Geisinger Heart Institute, MC 36-10, 1000 East Mountain Boulevard, Wilkes-Barre, Pennsylvania 18711.
Cardiac pacing is an effective treatment for patients with bradycardia due to sinus node dysfunction or atrioventricular block. Despite decades of technological advances, the optimal ventricular pacing site to mimic normal human ventricular physiology and best hemodynamic response remains elusive. Beginning with atrial synchronous right ventricular (RV) apical pacing, the search has continued through alternate RV pacing sites, minimizing RV pacing, biventricular pacing, left ventricular (LV) pacing, and His-bundle pacing. Understanding the deleterious effects of long-term RV apical pacing in vulnerable populations has created tremendous interest in alternate pacing options. This paper reviews the current status of available pacing options, with particular focus on His-bundle pacing. Permanent His-bundle pacing has emerged as the leading candidate for physiological pacing because it provides nearly normal electrical activation of both ventricles and thereby avoids ventricular dyssynchrony. Synchronized LV pacing, multisite LV pacing, and LV endocardial pacing offer promise as novel pacing options in select patients.
Dr. Vijayaraman has served on the advisory board of Boston Scientific; and has been a speaker, consultant for, and received honoraria from Medtronic. Dr. Ellenbogen has served on the advisory board of, received honoraria from, and been a consultant for Medtronic, Boston Scientific, and St. Jude Medical; has received honoraria from Biotronik; has received research support from Medtronic and Boston Scientific; and has received institutional support from Medtronic and Boston Scientific. Dr. Bordachar has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received April 17, 2017.
- Accepted May 3, 2017.
- 2017 American College of Cardiology Foundation