Letter from the Editor in Chief
DOI: 10.19102/icrm.2023.14106
MOUSSA MANSOUR, MD, FHRS, FACC
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Dr. Mansour reports the reception of research grants from Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Medtronic, Pfizer, Boehringer Ingelheim, and SentreHeart. He is also a consultant for Abbott Laboratories, Biosense Webster, Johnson & Johnson, Boston Scientific, Janssen, Medtronic, Phillips, Novartis, and SentreHeart and reports an equity relationship with EPS Solutions. All aforementioned relationships are in the area of atrial fibrillation; Dr. Mansour additionally reports an equity relationship in the area of ventricular fibrillation with NewPace Ltd.
Dear readers,
Interest in physiologic pacing, including left bundle area pacing, has grown over the past few years due to the lack of responsiveness to biventricular pacing in many patients and the deleterious effect of chronic right ventricular (RV) pacing. However, current literature estimates of the burden of RV pacing in patients undergoing pacemaker implantation vary widely.1,2 As such, better knowledge of the rate of RV pacing may facilitate the adoption of physiologic pacing over RV pacing.
This issue of The Journal of Innovations in Cardiac Rhythm Management contains an important article titled “Exploring the Temporal Patterns of Right Ventricular Pacing Burden,” in which Chattopadhyay et al.3 report the findings of a retrospective study analyzing the burden of RV pacing in 1263 patients who underwent pacing for bradycardia during a 5-year period. The study contains several important findings, including that the overall burden of RV was higher than previously reported and remained stable over time. Also, patients with sinus node dysfunction continued to have a low burden of RV pacing when the initial P–R interval was <250 ms, but this was not true in cases where the interval was >250 ms, wherein the burden of RV pacing exceeds 70%.
Biventricular pacing is superior to conventional RV pacing in patients with atrioventricular block and left ventricular (LV) dysfunction.4 Meanwhile, there are no data concerning the role of advanced pacing strategies, such as physiologic pacing, in patients with bradycardia and preserved LV function. The described study by Chattopadhyay et al. reporting that all patient groups, except those with sinus node dysfunction and short P–R intervals, can be expected to have a high burden of RV pacing makes a strong case for considering physiologic pacing in most patients, even when the LV function is preserved. At a minimum, the study findings highlight an urgent need for the completion of randomized studies comparing physiologic and RV pacing in patients with normal LV function. This study and others may accelerate the development of technologies to facilitate and improve physiologic pacing.
Sincerely,
Moussa Mansour, MD, FHRS, FACC
Editor in Chief
The Journal of Innovations in Cardiac Rhythm Management
Director, Atrial Fibrillation Program
Jeremy Ruskin and Dan Starks Endowed Chair in Cardiology
Massachusetts General Hospital
Boston, MA 02114
References
- Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427–3520. [CrossRef] [PubMed]
- Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients with Bradycardia and Cardiac Conduction Delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):e51–e156. [CrossRef] [PubMed]
- Chattopadhyay RK, Thakur M, Wickramasinghe R, et al. Exploring the temporal patterns of right ventricular pacing burden. J Innov Cardiac Rhythm Manage. 2023;14(10):5605–5609. [CrossRef]
- Curtis AB, Worley SJ, Adamson PB, et al. Biventricular pacing for atrioventricular block and systolic dysfunction. N Engl J Med. 2013;368(17):1585–1593. [CrossRef] [PubMed]
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