Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Overview of cardiac pacing in heart failure

Leslie A Saxon, MD
Section Editor
Wilson S Colucci, MD
Deputy Editor
Susan B Yeon, MD, JD, FACC


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 "Implantable cardioverter-defibrillators: Overview of indications, components, and functions" 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".)


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.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 16, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Saxon LA, Stevenson WG, Middlekauff HR, Stevenson LW. Increased risk of progressive hemodynamic deterioration in advanced heart failure patients requiring permanent pacemakers. Am Heart J 1993; 125:1306.
  2. Auricchio A, Salo RW. Acute hemodynamic improvement by pacing in patients with severe congestive heart failure. Pacing Clin Electrophysiol 1997; 20:313.
  3. Hochleitner M, Hörtnagl H, Ng CK, et al. Usefulness of physiologic dual-chamber pacing in drug-resistant idiopathic dilated cardiomyopathy. Am J Cardiol 1990; 66:198.
  4. Hochleitner M, Hörtnagl H, Hörtnagl H, et al. Long-term efficacy of physiologic dual-chamber pacing in the treatment of end-stage idiopathic dilated cardiomyopathy. Am J Cardiol 1992; 70:1320.
  5. Wilkoff BL, Cook JR, Epstein AE, et al. Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial. JAMA 2002; 288:3115.
  6. Sweeney MO, Prinzen FW. A new paradigm for physiologic ventricular pacing. J Am Coll Cardiol 2006; 47:282.
  7. Hayes JJ, Sharma AD, Love JC, et al. Abnormal conduction increases risk of adverse outcomes from right ventricular pacing. J Am Coll Cardiol 2006; 48:1628.
  8. Sweeney MO, Hellkamp AS, Ellenbogen KA, et al. Adverse effect of ventricular pacing on heart failure and atrial fibrillation among patients with normal baseline QRS duration in a clinical trial of pacemaker therapy for sinus node dysfunction. Circulation 2003; 107:2932.
  9. Rossi R, Muia N Jr, Turco V, et al. Short atrioventricular delay reduces the degree of mitral regurgitation in patients with a sequential dual-chamber pacemaker. Am J Cardiol 1997; 80:901.
  10. Shinbane JS, Chu E, DeMarco T, et al. Evaluation of acute dual-chamber pacing with a range of atrioventricular delays on cardiac performance in refractory heart failure. J Am Coll Cardiol 1997; 30:1295.
  11. Capucci A, Romano S, Puglisi A, et al. Dual chamber pacing with optimal AV delay in congestive heart failure: a randomized study. Europace 1999; 1:174.
  12. Wilkoff BL, Kudenchuk PJ, Buxton AE, et al. The DAVID (Dual Chamber and VVI Implantable Defibrillator) II trial. J Am Coll Cardiol 2009; 53:872.
  13. http://www.fac.org.ar/qcvc/llave/c121i/levinep.php (Accessed on December 08, 2014).
  14. Epstein AE, DiMarco JP, Ellenbogen KA, et al. ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices): developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Circulation 2008; 117:e350.
  15. Goldenberg I, Moss AJ, Hall WJ, et al. Causes and consequences of heart failure after prophylactic implantation of a defibrillator in the multicenter automatic defibrillator implantation trial II. Circulation 2006; 113:2810.
  16. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62:e147.
  17. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129.
  18. http://www.heartfailureguideline.org/guideline_sections/41 (Accessed on May 29, 2012).
  19. Stevenson WG, Hernandez AF, Carson PE, et al. Indications for cardiac resynchronization therapy: 2011 update from the Heart Failure Society of America Guideline Committee. J Card Fail 2012; 18:94.