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  • Title: [Right ventricular outflow tract versus right ventricular apex--why few centimetres is so important in cardiac pacing].
    Author: Szafraniec Z, Wranicz JK.
    Journal: Pol Merkur Lekarski; 2014 Sep; 37(219):139-43. PubMed ID: 25345272.
    Abstract:
    Development of device therapy constituted a milestone in the treatment of patients with systolic heart failure. Nowadays the majority of patients with systolic heart failure receive an implantable cardioverter-defibrillator (ICD), which very effectively protects them from sudden cardiac death, and patients with so-called electrical dyssynchrony, defined as significant widening of the QRS complexes in the ECG, are qualified to cardiac resynchronization therapy (CRT-D). Most of the patients implanted with ICD will not require constant or frequent ventricular pacing, however, a not inconsiderable group treated optimally (including beta-blockers) will require backup pacing. Since DAVID trial we know that pacing of the right ventricular apex harms patients with heart failure. This knowledge led to development of alternative sites, of which the most widely adopted the outflow tract of the right ventricle. The aim of this paper was to review the most important available data on right ventricular pacing in patients with heart failure and to familiarize physicians with this very hot topic of modem electrotherapy. The development of newer implantation techniques and technological progress in the field of cardiac devices, as well as considerable practical experience in the field has led to situation, where implanting leads into the RVOT in patients with heart failure is a safe procedure and should be preferred in those patients who will require frequent right ventricular pacing.
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