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Europace 2003 5(3):275-278; doi:10.1016/S1099-5129(03)00031-X
© 2003 by European Society of Cardiology
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Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing

A quantitative review

C. C. de Cock1, M. C. Giudici2 and J. W. Twisk3

1Department of Cardiology, VU Medical Center Boelelaan 1117, 1081 HV Amsterdam, The Netherlands; 2Department of Cardiology, Genesis Regional Heart Center 1230 East Rusholme, Davenport, IA 52803, U.S.A.; 3Department of Clinical Epidemiology and Biostatistics, EMGO Institute VU Medical Center Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

The right ventricular apex has been used for cardiac stimulation because this position is easily accessible and is associated with a stable position of the electrode with a low dislodgement rate. This position, however, is associated with a dyssynchronous left ventricular contraction with subsequent deleterious haemodynamic effects. Alternative stimulation sites have been studied extensively because of a potentially better haemodynamic effect compared with right ventricular apex pacing.

Using a Cochrane search strategy, nine studies were selected to analyze the haemodynamic effects of right ventricular outflow-tract pacing. The results of these studies (n=217) were pooled and indicated a significantly better haemodynamic effect (odds ratio 0.34, confidence interval 0.15–0.53) compared with right ventricular apex pacing. Therefore, these data suggest that right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.

Key Words: Right ventricular outflow-tract pacing, haemodynamics

Correspondence: C. C. de Cook, Department of Cardiology, VU Medical Center, 6 Noord 120, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands. Tel.: +31-20-444-22-44; Fax: +31-20-444-24-46; E-mail: c.c.dcock{at}azvu.nl


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