Pacing-induced heart disease: understanding the pathophysiology and improving outcomes

Abstract

Pacemaker implantation remains the only therapeutic option that improves morbidity and mortality for patients with symptomatic bradycardia. However, pacing from the right ventricular apex can induce dyssynchronous activation of the ventricles, increase sympathetic activation, cause abnormalities in myocardial perfusion, worsen cardiac output and endothelial function and may be associated with adverse cardiovascular outcomes. This article reviews the current knowledge on the pathophysiology of pacing-induced cardiovascular disease and current strategies to avoid and mitigate the adverse effects of right ventricular pacing.

Keywords::

• biventricular pacemaker
• endothelial dysfunction
• heart failure
• pacing site
• right ventricular pacing
• ventricular dyssynchrony

Financial & competing interests disclosure

Anna Maria Choy and Douglas HJ Elder have received a moderate research funding grant from St Jude Medical. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.