DDD Pacing in Dilated Cardiomyopathy

Abstract

It is well recognised that pacing from a right ventricular site leads to abnormal left ventricular activation, and thus loss of the normal physiological contraction pattern. When a DDD pacemaker is inserted for abnormal atrioventricular conduction, left ventricular contraction is not impaired, so that any deterioration caused by abnormal activation is of no physiological consequence. DDD pacing has been proposed, however, in patients with dilated cardiomyopathy in whom left ventricular function may be profoundly impaired [1]. At first sight, this would seem paradoxical; if benefit were to occur, it is likely to be seen in patients in whom ventricular activation is so abnormal under control conditions that it is actually contributing significantly to the overall impairment of ventricular function.