Transvenous pacemaker lead implantation is the preferred method of pacing in adult patients. Lead performance and longevity are superior and the implantation approach can be performed under local anaesthetic with a very low morbidity. In children, and especially in neonates and infants, the epicardial route was traditionally chosen until the advent of smaller generators and lead implantation te...

BACKGROUND Chronic right ventricular pacing (RVP) induces a dyssynchronous contraction pattern,producing interventricular and intraventricular asynchrony. Many studies have shown the relationship of RVP with impaired left ventricular (LV) form and function. OBJECTIVE The aim of this study was to evaluate LV synchrony and function in pediatric patients receiving RVP in comparison with those re...

BACKGROUND Biventricular (BiV) pacing is the most common mode of delivering cardiac resynchronization therapy (CRT). However, initial clinical studies have indicated that left ventricular (LV) pacing is not inferior to BiV pacing. This study was conducted to address whether LV only pacing can provide the same hemodynamic response as BiV pacing. METHODS This before-after clinical trial was con...

Introduction Left ventricular (LV) endocardial pacing is a relatively new therapy that may offer several advantages over coronary venous lead placement for biventricular resynchronization therapy, including access to more regions of the LV, faster impulse propagation, avoidance of phrenic nerve stimulation, and more physiologic LV activation. We report a case of transseptal implantation of a pa...

Upgrading of a pacing system in the presence of a subclavian occlusion is technically challenging. We describe the case of a patient who underwent a successful upgrading procedure of an implantable cardioverter-defibrillator (ICD) to a biventricular defibrillator (ICD-CRT) in the presence of a suboccluded left subclavian vein, using a collateral vein that drained into the contralateral subclavi...

The quantification of ventricular dyssynchrony is a key factor in identifying patients with severe heart failure who may benefit from cardiac resynchronisation with biventricular pacing (BVP). Echocardiographic techniques appear to offer superior sensitivity and specificity than the ECG in selecting these patients. This paper reviews the scope of current echocardiographic techniques for guiding...

Although our current appreciation of the detrimental role of neurohumoral activation in heart failure (HF) has been intellectually appealing and has led to neurohumoral antagonism that has reduced morbidity and mortality from HF, the persisting disability and death rates remain unacceptably high. In the search for novel strategies to improve on these outcomes, we must reacquaint ourselves with ...

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...

In recent years, cardiac resynchronization therapy or biventricular pacing has been proved to be effective in alleviating congestive heart failure in 70% of patients. For patients who have bradycardia devices in place before presentation of heart failure and the devices are well before end of life, the RV pacing system can be effectively, efficiently and safely upgraded to bi-ventricular pacing...

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...