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2016 ; 68
(4
): 552-8
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Physiological cardiac pacing: Current status
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Das A
; Kahali D
Indian Heart J
2016[Jul]; 68
(4
): 552-8
PMID27543481
show ga
Adverse hemodynamics of right ventricular (RV) pacing is a well-known fact. It
was believed to be the result of atrio-ventricular (AV) dyssynchrony and
sequential pacing of the atrium and ventricle may solve these problems. However,
despite maintenance of AV synchrony, the dual chamber pacemakers in different
trials have failed to show its superiority over single chamber RV apical pacing
in terms of death, progression of heart failure, and atrial fibrillation (AF). As
a consequence, investigators searched for alternate pacing sites with a more
physiological activation pattern and better hemodynamics. Direct His bundle
pacing and Para-Hisian pacing are the most physiological ventricular pacing
sites. But, this is technically difficult. Ventricular septal pacing compared to
apical pacing results in a shorter electrical activation delay and consequently
less mechanical dyssynchrony. But, the study results are heterogeneous. Selective
site atria pacing (atrial septal) is useful for patients with atrial conduction
disorders in prevention of AF.