Conus Arteriosus as an Alternate Pacing Site

Since pacing for bradycardia began in the 1960 s, physicians and medical device companies have focused on improving the software, hardware and longevity of implantable device, without paying substantial attention to the optimal pacing site within the right ventricle (RV). Historically, apical pacing within the RV was chosen as it was easily accessible, the lead placements were relatively stable and/or rates of dislodgement/infections were low. However, more recent studies have suggested potential deleterious effects of long-term RV apical pacing: i.e., some degree of induced heart failure with associated decreased hemodynamic [1] or ventricular function [2]. Both short-term [3] and long-term [4] studies on humans have confirmed these suggested adverse effects, more specifically including, abnormal ventricular activation times, right and left ventricular dysfunctions, which have been linked to genesis of heart failure. These observations have fuelled growing interest to perform alternate site pacing,...