ISSN: 1305-385X
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New Indication For Cardiac Pacing
Dr. Kamil ADALETa
aKardiyoloji AD, İstanbul Üniversitesi İstanbul Tıp Fakültesi, İSTANBUL
In recent years, a variety of new pacing indications have emerged. The alternative or dual atrial pacing sites and various pacing algorithms to suppress atrial fibrillation has been evaluated in patients with and without sick sinus syndrome; clinical benefits have been limited and inconsistent. In patients with long QT syndrome, pacing may be useful as an adjunct to beta-blockers for the prevention of pause-dependent ventricular arrhythmias, but implantable cardioverter defibrillator (ICD) should be preferred in high risk patients. The use of pacing in malign vasovagal syndrome with a cardio-inhibitory response to head-up tilt testing is more controversial. Although some trials have shown a reduction in syncope with pacing, more recent controlled studies have shown no clear benefit. In patients with hypertrophic cardiomyopathy, pacing may reduce the left ventricular outflow tract gradient and clinical improvement has been reported in randomized trials. However, the clinical benefit does not correlate well gradient reduction, and other therapy options (septal alcohol ablation, myectomy) should be considered in severely symptomatic patients. These therapy modalities have no effect on cardiac mortality, and ICD should be implanted in high risk groups. The biventricular pacing for cardiac resynchronization may be useful in selected patients with heart failure. Current European Society of Cardiology guidelines recommend cardiac resynchronization therapy (CRT) in patients with medically refractory, symptomatic NYHA class III or IV heart failure with dilated cardiomyopathy, prolonged QRS interval (>120 msec), left ventricular diastolic diameter>55 mm and LVEF<35%. The ICD implantation may be reduced mortality in these patients.
As a conclusion, cardiac pacing may be of benefit in selected patients with various conditions other than symptomatic bradycardia.Keywords: Atrial fibrillation, cardiac resynchronization therapy, hypertrophic cardiomyopathy, long QT syndrome, pacemaker, vasovagal syncopeTurkiye Klinikleri J Int Med Sci 2006, 2(24):53-64
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