Physiological pacing has been a term that has been used to describe many phenomena. It was used over 30 years ago to describe the advent of AV synchronous or dual chamber pacing, later the addition of the rate-responsive mode to pacing, and even more recently to describe biventricular pacing. In the last several years, there has been a resurgence of interest in pacing the conduction system: sel...

Most current pacemaker and ICD systems involve placement of lead(s) transvenously into the heart, connected to a pulse generator. Vascular access may be difficult or limited in some patients, and intravascular leads can be associated with multiple complications such as infection, lead malfunction and vascular occlusion. Recent advances in pacing and ICDs include the development of subcutaneous ...

Cardiac resynchronization therapy (CRT) is a proven treatment for heart failure but ~30% of patients appear to not benefit from the therapy. Left ventricular (LV) endocardial and multisite epicardial [triventricular (TriV)] pacing have been proposed as alternatives to traditional LV transvenous epicardial pacing, but no study has directly compared the hemodynamic effects of these approaches. Le...

INTRODUCTION Recent efforts to increase CRT response by multiSPOT pacing (MSP) from multiple bipols on the same left ventricular lead are still inconclusive. AIM The Left Ventricular (LV) MultiSPOTpacing for CRT (iSPOT) study compared the acute hemodynamic response of MSP pacing by using 3 electrodes on a quadripolar lead compared with conventional biventricular pacing (BiV). METHODS Patien...

BACKGROUND A recently completed trial, the Canadian Trial of Physiological Pacing (CTOPP), showed that physiological pacing did not significantly reduce mortality, stroke, or heart failure hospitalization, but it did show that atrial fibrillation occurred less frequently in patients with physiological pacing. Many pacemaker patients experience only transient bradyarrhythmias with an adequate un...

Figure 1 Changes in the 12-lead electrocardiograms (ECGs) during biventricular pacing with different left ventricular (LV) pacing configurations. A: Extended bipolar pacing between LV1 and right ventricular coil. B: Extended bipolar pacing between LV4 and right ventricular coil. C: LV bipolar pacing between LV1 (anode) and LV4 (cathode) with an output of 4.0 V/0.4 ms. The similar morphology to ...

The right ventricular (RV) apex has been the standard pacing site since the development of implantable pacemaker technology. Although RV pacing was initially only utilized for the treatment of severe bradyarrhythmias usually due to complete heart block, today the indications for and implantation of RV pacing devices is dramatically larger. Recently, the adverse effects of chronic RV apical paci...

Right ventricular (RV) pacing has been reported to result in ventricular dyssynchrony, heart failure, and increased mortality. Pacing associated deterioration of left ventricular (LV) systolic function has been termed pacing-induced cardiomyopathy (PICM). While upgrading to biventricular pacing (BiVP) is an effective therapy for PICM, permanent His-bundle pacing (HBP) can be a physiological alt...

Traditional right ventricular pacing prolongs the electrical and mechanical activation of the heart, which reduces the pump function, and in selected patients may lead to pacing-induced heart failure. Pacing the His bundle preserves the normal or near-normal activation pattern of the ventricles that prevents the detrimental effects of right ventricular pacing. This review discusses the techniqu...

OBJECTIVES The Homburg Biventricular Pacing Evaluation (HOBIPACE) is the first randomized controlled study that compares the biventricular (BV) pacing approach with conventional right ventricular (RV) pacing in patients with left ventricular (LV) dysfunction and a standard indication for antibradycardia pacing in the ventricle. BACKGROUND In patients with LV dysfunction and atrioventricular b...