Overview of cardiac pacing in heart failure
- Leslie A Saxon, MD
Leslie A Saxon, MD
- Professor of Medicine
- University of Southern California
Medical therapies, such as angiotensin converting enzyme inhibitors, beta blockers, angiotensin II receptor blockers, and aldosterone antagonists, improve symptom control and overall survival in patients with heart failure (HF) due to systolic dysfunction. (See "Overview of the therapy of heart failure with reduced ejection fraction".)
Implanted devices, such as cardiac pacemakers and implantable cardioverter-defibrillators (ICDs), have also become an increasingly used component of the management of HF patients. The impact of cardiac implantable electronic devices on the incidence and progression of HF is complex, and depends upon both the nature of the device (eg, single chamber, dual chamber, or biventricular pacemaker, or an ICD), and device programming.
The role of cardiac implantable electronic devices in patients with HF will be reviewed here. The general indications for ICDs, permanent pacemakers, and the various modes of cardiac pacing are discussed separately. (See "General principles of the implantable cardioverter-defibrillator" and "Primary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Secondary prevention of sudden cardiac death in heart failure and cardiomyopathy" and "Permanent cardiac pacing: Overview of devices and indications" and "Modes of cardiac pacing: Nomenclature and selection".)
RIGHT VENTRICULAR PACING
RV pacing as a cause of dyssynchrony — Data from both retrospective analyses and a randomized trial have demonstrated that right ventricular (RV) pacing can exacerbate heart failure (HF). (See 'Role of pacing mode' below.)
The following sequence is thought to explain the mechanism of the adverse effect of RV pacing.
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- RIGHT VENTRICULAR PACING
- RV pacing as a cause of dyssynchrony
- Role of pacing mode
- - Dual-chamber pacing
- DAVID trial
- MOST trial
- Treatment of MR and AV delay optimization
- - Pacing modes to avoid or limit RV pacing
- BIVENTRICULAR PACING
- IMPLANTABLE CARDIOVERTER-DEFIBRILLATORS
- General considerations
- Device selection and programming
- Major society guidelines
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS