Skip to main content
SpringerLink
Log in

Endocardial Pacing: The Wave of the Future?

  • Invasive Electrophysiology and Pacing (J Singh, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure and requires the implantation of a left ventricular (LV) lead, usually placed in a tributary of the coronary sinus. Encouraged by the fact that approximately 30 % of the patients receiving CRT do not benefit from this therapy, LV endocardial pacing has been proposed as an alternative to traditional LV transvenous epicardial pacing. Endocardial LV pacing has a number of potential advantages over conventional LV epicardial pacing, including a more physiological endocardial-to-epicardial transmural activation sequence, a faster ventricular activation, a larger choice of stimulation sites and a potential superior hemodynamic performance. On the other hand, cardiologists will have to deal with new implant techniques’ (transseptal), higher risk of thromboembolic events, and challenging extraction procedures of infected material. The future of endocardial stimulation will depend on the results of randomized studies adequately powered to assess the feasibility, the safety and the effectiveness of this new pacing strategy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. J Am Coll Cardiol. 2008;51:e1–e62.

    Article  PubMed  Google Scholar 

  2. Dickstein K, Vardas PE, Auricchio A, et al. 2010 Focused Update of ESC Guidelines on device therapy in heart failure: an update of the 2008 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure and the 2007 ESC guidelines for cardiac and resynchronization therapy. Developed with the special contribution of the Heart Failure Association and the European Heart Rhythm Association. Eur Heart J. 2010;31:2677–87.

    Article  PubMed  Google Scholar 

  3. Cazeau S, Leclercq C, Lavergne T, et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001;344:873–80.

    Article  PubMed  CAS  Google Scholar 

  4. Cleland JG, Daubert JC, Erdmann E, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–49.

    Article  PubMed  CAS  Google Scholar 

  5. Jais P, Douard H, Shah DC, et al. Endocardial biventricular pacing. Pacing Clin Electrophysiol. 1998;21(11 Pt 1):2128–31.

    Article  PubMed  CAS  Google Scholar 

  6. Leclercq F, Hager FX, Macia JC, et al. Left ventricular lead insertion using a modified transseptal catheterization technique: a totally endocardial approach for permanent biventricular pacing in end-stage heart failure. Pacing Clin Electrophysiol. 1999;22:1570–5.

    Article  PubMed  CAS  Google Scholar 

  7. Jais P, Takahashi A, Garrigue S, et al. Mid-term follow-up of endocardial biventricular pacing. Pacing Clin Electrophysiol. 2000;23(11 Pt 2):1744–7.

    PubMed  CAS  Google Scholar 

  8. Nuta B, Lines I, MacIntyre I, Haywood GA. Biventricular ICD implant using endocardial LV lead placement from the left subclavian vein approach and transseptal puncture via the transfemoral route. Europace. 2007;9:1038–40.

    Article  PubMed  Google Scholar 

  9. •• Morgan JM, Scott PA, Turner NG, et al. Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead. Europace. 2009;11:502–6. This article has demonstrated the feasibility of a combined femoral and subclavian approach for left ventricular endocardial pacing.

    Article  PubMed  Google Scholar 

  10. Bracke FA, Houthuizen P, Rahel BM, van Gelder BM. Left ventricular endocardial pacing improves the clinical efficacy in a non-responder to cardiac resynchronization therapy: role of acute haemodynamic testing. Europace. 2010;12:1032–4.

    Article  PubMed  Google Scholar 

  11. Ploux S, Whinnett Z, Bordachar P. Left ventricular endocardial pacing and multisite pacing to improve CRT response. J Cardiovasc Transl Res. 2012;5:213–8.

    Article  PubMed  Google Scholar 

  12. Whinnett Z, Bordachar P. The risks and benefits of transseptal endocardial pacing. Curr Opin Cardiol. 2012;27:19–23.

    Article  PubMed  Google Scholar 

  13. Reinig M, White M, Levine M, et al. Left ventricular endocardial pacing: a transarterial approach. Pacing Clin Electrophysiol. 2007;30:1464–8.

    Article  PubMed  Google Scholar 

  14. Lepore V, Pizzarelli G, Dernevik L. Inadvertent transarterial pacemaker insertion: an unusual complication. Pacing Clin Electrophysiol. 1987;10(4 Pt 1):951–4.

    Article  PubMed  CAS  Google Scholar 

  15. Reising S, Safford R, Castello R, et al. A stroke of bad luck: left ventricular pacemaker malposition. J Am Soc Echocardiogr. 2007;20:1316 e1–3.

    Google Scholar 

  16. Kassai I, Foldesi C, Szekely A, Szili-Torok T. Alternative method for cardiac resynchronization: transapical lead implantation. Ann Thorac Surg. 2009;87:650–2.

    Article  PubMed  Google Scholar 

  17. Kassai I, Mihalcz A, Foldesi C, et al. A novel approach for endocardial resynchronization therapy: initial experience with transapical implantation of the left ventricular lead. Heart Surg Forum. 2009;12:E137–40.

    Article  PubMed  Google Scholar 

  18. van Gelder BM, Scheffer MG, Meijer A, Bracke FA. Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy. Heart Rhythm. 2007;4:454–60.

    Article  PubMed  Google Scholar 

  19. Ji S, Cesario DA, Swerdlow CD, Shivkumar K. Left ventricular endocardial lead placement using a modified transseptal approach. J Cardiovasc Electrophysiol. 2004;15:234–6.

    Article  PubMed  Google Scholar 

  20. Lau EW. A streamlined technique of trans-septal endocardial left ventricular lead placement. J Interv Card Electrophysiol. 2009;26:73–81.

    Article  PubMed  Google Scholar 

  21. Fish JM, Di Diego JM, Nesterenko V, Antzelevitch C. Epicardial activation of left ventricular wall prolongs QT interval and transmural dispersion of repolarization: implications for biventricular pacing. Circulation. 2004;109:2136–42.

    Article  PubMed  Google Scholar 

  22. •• Derval N, Steendijk P, Gula LJ, et al. Optimizing hemodynamics in heart failure patients by systematic screening of left ventricular pacing sites: the lateral left ventricular wall and the coronary sinus are rarely the best sites. J Am Coll Cardiol. 2010;55:566–75. This clinical article has demonstrated the hemodynamic interest of an optimization of the left ventricular endocardial pacing site.

    Article  PubMed  Google Scholar 

  23. •• van Deursen C, van Geldorp IE, Rademakers LM, et al. Left ventricular endocardial pacing improves resynchronization therapy in canine left bundle-branch hearts. Circ Arrhythm Electrophysiol. 2009;2:580–7. This very important article has demonstrated the hemodynamic superiority of endocardial versus epicardial left ventricular pacing in a canine model of left bundle branch block.

    Article  PubMed  Google Scholar 

  24. Strik M, Rademakers LM, van Deursen CJ, et al. Endocardial left ventricular pacing improves cardiac resynchronization therapy in chronic asynchronous infarction and heart failure models. Circ Arrhythm Electrophysiol. 2011.

  25. Spragg DD, Dong J, Fetics BJ, et al. Optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2010;56:774–81.

    Article  PubMed  Google Scholar 

  26. Pasquie JL, Massin F, Macia JC, et al. Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure. Pacing Clin Electrophysiol. 2007;30 Suppl 1:S31–3.

    PubMed  Google Scholar 

  27. Van Gelder BM, Bracke FA, Oto A, et al. Diagnosis and management of inadvertently placed pacing and ICD leads in the left ventricle: a multicenter experience and review of the literature. Pacing Clin Electrophysiol. 2000;23:877–83.

    Article  PubMed  Google Scholar 

  28. Echt DS, Cowan MW, Riley RE, Brisken AF. Feasibility and safety of a novel technology for pacing without leads. Heart Rhythm. 2006;3:1202–6.

    Article  PubMed  Google Scholar 

  29. Wieneke H, Konorza T, Erbel R, Kisker E. Leadless pacing of the heart using induction technology: a feasibility study. Pacing Clin Electrophysiol. 2009;32:177–83.

    Article  PubMed  Google Scholar 

Download references

Acknowledgment

S. Ploux is supported by a grant from the Fédération Française de Cardiologie.

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Bordeaux 2 University, Bordeaux, France

    Pierre Bordachar & Sylvain Ploux

  2. University Hospital of Bordeaux, Bordeaux, France

    Pierre Bordachar & Sylvain Ploux

  3. Department of Biomedical Engineering, Maastricht University Medical Center, Maastricht, The Netherlands

    Joost Lumens

  4. Hospital Haut Leveque, Service Pr. Haissaguerre, Pessac, 33604, France

    Pierre Bordachar

Authors
  1. Pierre Bordachar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sylvain Ploux
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joost Lumens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pierre Bordachar.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bordachar, P., Ploux, S. & Lumens, J. Endocardial Pacing: The Wave of the Future?. Curr Cardiol Rep 14, 547–551 (2012). https://doi.org/10.1007/s11886-012-0298-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11886-012-0298-2

Keywords

Search

Navigation