Routine use of biventricular pacing is not warranted for patients with heart block.

Abstract

Ventricular pacing can be lifesaving for patients with complete atrioventricular block (AVB). Since the introduction of permanent transvenous cardiac pacing >40 years ago, the right ventricular (RV) apex has been the preferred site for ventricular stimulation. This location provides good fixation and low capture thresholds. However, RV apical pacing may induce cardiac dyssynchrony. Hence, it has been suggested that all patients with symptomatic AVB (regardless of current indication for biventricular pacing), with anticipated high RV pacing burden, should receive preventive biventricular pacing. In this article, we review the physiological effects of RV pacing, data from observational studies (Table I in the Data Supplement),1–6 and available randomized trials comparing biventricular versus RV pacing (Table).7–16 View this table: Table. Randomized Controlled Studies Comparing Right Ventricular and Biventricular Pacing Response by Fang et al on p 738 Since the initial report of the use of endocardial pacing to treat complete AVB by Furman and Schwedel in 195917, pacemakers have evolved dramatically into complex devices with the ability to sequentially pace the atrium and both ventricles. Between 1993 and 2009, 2.9 million patients received a permanent pacemaker in the United States.18 During this time, overall pacemaker use increased by 55.6%. However, although the use of dual chamber (DDD) pacemakers increased by at least 40%, the use of single-chamber ventricular (VVI) pacemakers decreased ≈50%,18 despite the evidence from large pacing trials19–21 indicating no major differences in outcomes between single and dual chamber pacing modes. In fact, by 2009, DDD pacemakers accounted for 82% of all implants (VVI for only 14%).18 These statistics speak loudly about the impact of technology on daily clinical practice. A similar quandary now exists with regards to biventricular pacing. We suggest that the global utilization of biventricular pacing for all …