Accentuation of Pacing Induced Electrical Dyssynchrony by Preexisting Conduction System Disease and Left Ventricular Dysfunction

摘要

Right ventricular (RV) transvenous pacing was developed in the 1970s and has revolutionized the treatment of individuals with symptomatic bradycardia. Development of transvenous leads allowed for relatively simple pacemaker implantation, with low morbidity and mortality. RV pacing has allowed patients with heart block to regain AV synchrony, and the addition of an RV lead to individuals with sinus node dysfunction has become routine because of the concern about subsequent development of heart block. The shortcomings of RV pacing have only more recently been appreciated. RV pacing may have deleterious short-term effects based on the propagation of the RV impulse through the myocardium (left ventricular [LV] dyssynchrony) and long-term deleterious effects of myocardial remodeling that may ultimately lead to myocardial dysfunction#