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Right Heart in Cardiac Pacing

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Right Heart Pathology

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Abstract

Conventional right heart pacing with leads placed at the right atrial appendage (RAA) and right ventricular (RV) apex produces iatrogenic dyssynchrony. Atrial dysssynchrony may favor the development of atrial tachyarrhythmias, but the data have been relatively limited and have not yet had any influence on clinical practice. However, the evidence of deleterious effects of the iatrogenic dyssynchrony in the form of left bundle branch block (LBBB) which is produced by RV apical pacing has been compelling and has led to some degree of a paradigm shift in our approach to conventional RV pacing by adopting selective site pacing and avoiding the RV apex, at least for patients with left ventricular (LV) dysfunction and/or heart failure, who are the ones who seem to be afflicted the most and are apparently better responders to non-RV apical pacing. The type of inter- and intra-ventricular dyssynchrony produced by classical RV apical pacing (iatrogenic LBBB) leads to pacing-induced cardiomyopathy similar to the dyssynchrony conferred by spontaneous LBBB, both manageable by biventricular pacing or cardiac resynchronization therapy (CRT). The evidence regarding the adverse effects of conventional right heart pacing is analyzed and reviewed in this chapter together with the data concerning selective or alternate site right heart pacing.

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Abbreviations

AF:

Atrial fibrillation

AV:

Atrioventricular

CRT:

Cardiac resynchronization therapy

ICD:

Implantable cardioverter defibrillator

LBBB:

Left bundle branch block

LV:

Left ventric-le(-ular)

LVEF:

Left ventricular ejection fraction

RAA:

Right atrial appendage

RV:

Right ventric-le(-ular)

RVA:

Right ventricular apex

RVOT:

Right ventricular outflow tract

RVS:

Right ventricular septum

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Authors and Affiliations

  1. Third Department of Cardiology, Athens University School of Medicine, Athens, Greece

    Antonis S. Manolis

  2. Patras University School of Medicine, Patras, Greece

    Antonis A. Manolis

  3. Zakynthos Hospital, Zakynthos, Greece

    Theodora A. Manolis

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  1. Antonis S. Manolis
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  2. Antonis A. Manolis
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  3. Theodora A. Manolis
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Correspondence to Antonis S. Manolis .

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Editors and Affiliations

  1. Department of Medicine, Titu Maiorescu University, Bucharest, Romania

    Silviu Ionel Dumitrescu

  2. Department of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania

    Ion C. Ţintoiu

  3. Department of Surgery, Chinese University of Hong Kong, Sha Tin, Hong Kong

    Malcolm John Underwood

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Manolis, A.S., Manolis, A.A., Manolis, T.A. (2018). Right Heart in Cardiac Pacing. In: Dumitrescu, S., Ţintoiu, I., Underwood, M. (eds) Right Heart Pathology. Springer, Cham. https://doi.org/10.1007/978-3-319-73764-5_17

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