Should all patients with heart block receive biventricular pacing? All heart block patients with a pacemaker indication should receive biventricular pacing: one move, double the gains?

Abstract

Conventional right ventricular (RV) pacing can cause left ventricular (LV) dysfunction and even heart failure (HF) particularly if ventricular pacing is frequent.1 New onset HF has been observed in approximately one third of patients receiving RV pacing for acquired second- or third-degree atrioventricular block (AVB) after a median follow-up of nearly 8 years.2 An elegant study has shown recently that apparent pacing induced cardiomyopathy could occur even if the accumulative pacing percentage was <40%.1 Although there has been rapid progress in medication and device therapy for HF, it is still a burden on the public health systems and better prevention remains important.3 Avoiding the use of a potentially harmful device when a good alternative is available is a matter of serious consideration. Response by Arenas et al on p 729 Single- or dual-chamber pacemakers with RV pacing are undoubtedly the main therapy for symptomatic AVB. With increasing evidence of potential adverse effects of permanent RV pacing mainly because of systolic dyssynchrony,4,5 other pacing modalities or pacing modes are being considered. Biventricular pacing is one of the options and has been shown to be potentially superior to RV pacing even for those who require pacing but do not have a conventional indication for biventricular pacing.6,7 Biventricular pacing is emerging as a realistic treatment option to prevent RV pacing induced LV dysfunction for symptomatic patients with advanced AVB. Despite the lack of accurate epidemiology data for AVB, it is clear that it is not uncommon in both apparently healthy populations and those with overt heart disease. Approximately 1% to 2% of normal subjects have first-degree AVB which increases to 5% in men over the age of 60 with cardiac diseases.8–10 The prevalence of second-degree AVB for Mobitz II block …