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CZECH MEDICAL ASSOCIATION J. Ev. PURKYNĚ |
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Česky / Czech version | Vnitřní lékařství, 49, 2003, č. 9, s. 763 - 767 |
Heart Bradyarrhythmia Táborský M., Neužil P., Niederle P. Kardiologické oddělení Nemocnice Na Homolce, Praha, vedoucí prim. doc. MUDr. Petr Niederle, DrSc. |
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Summary: Permanent cardiac pacing was introduced in 1958 and till the end of 70s this method saved lives
in particular of the patients with advanced atrioventricular block. The implantation technique
has changed from complicated thoracotomy to endovasal approaches. The introduction of physiological
AV sequenced atrioventricular pacing marked a significant progress in this field. Acute
haemodynamic studies documented positive effect of the atrial contribution. Numerous studies
subsequently analyzed the influence of different pacing regimes on total and specific cardiovascular
mortality and morbidity. It can be concluded that on the basis of present evidence-based
medicine the use of physiological pacing is clearly indicated in the patients with expressed sinus
bradycardia and AV block of a higher degree. Atrial pacing remains an ideal solution for the
patients with isolated sinus node dysfunction and sufficient atrioventricular conduction capacity.
Research is continued in order to clarify how to influence the occurrence of ventricular fibrillation
by permanent cardiac pacing including the use of preventive algorithms. This topic has not yet
been reliably and unambiguously concluded. Biventricular pacing is currently established and
recognized not only for typical indications in cases of bradyarrhythmias but also to solve primary
haemodynamic problems in the patients with advanced heart failure and evidence of ventricular
dyssynchrony.
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