THE EVOLUTION OF THE PACING SITE: PAST, PRESENT AND FUTURE


Yasushi Oginosawa, M.D., University of Occupational and Environmental Health, Yahatanishi, Kitakyushu, Japan

As cardiac pacing system for bradyarrhythmias has been developed in clinical practice over half century, the preferential pacing site has been also evolved.[PAST] In the early stage, the object of the pacing was only maintenance of heart rate and pacing lead has been implanted to right atrial appendage and/or right ventricular apex for easiness in terms of implantation and the stability even using conventional passive fixation lead. [PRESENT] Since recent studies elucidated that pacing from those conventional sites result in deterioration of cardiac function and increasing co-morbidity, non-appendage or non-apical pacing has been chosen as alternative pacing sites to achieve more physiological cardiac activation. In addition, the cardiac resynchronization therapy (CRT) system using epicardial coronary sinus pacing lead is established for the heart failure patients with dyssynchrony of cardiac contraction. Although the variation of cardiac pacing site has been increased, it has not been elucidated which site is most effective for each patients. In this lecture, I would like to review the footsteps and importance of pacing site as well as expected pacing site enabled by promising new technologies for the [FUTURE].