Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing - A quantitative review

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. (C) 2003 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.