Dual-site right ventricular pacing. A rescue alternative in cardiac resynchronisation therapy implantation failure? More efficient stimulation for patients with borderline cardiac resynchronisation therapy indication? Less harmful ventricular pacing?

Permanent cardiac pacing is nowadays a widespread method for the cure of conduction system diseases, improving quality of life and often saving patients' lives. In the twentieth century, scientific efforts were focused on extending battery life, improving sensitivity and reliability, minimizing the dimensions of the device and restoring atrio-ventricular synchrony and rate response. However, there is more and more evidence for the deleterious influence of chronic right ventricular pacing especially apical (RVA) pacing. DANISH, MOST, CTOPP and DAVID trials have proven univocally that right ventricular pacing increases risk of heart failure, atrial fibrillation and even mortality in patients with chronic heart failure. Such knowledge inspires the quest for alternative pacing sites. Right ventricular outflow tract (RVOT) became the most favourable non-apical pacing site. Since 1995 there have been several reports concerning dual-site right ventricular pacing (DuVP: RVOT plus RVA pacing) proving its beneficial clinical and hemodynamic outcome especially in the case of unsuccessful left ventricle implantation for cardiac resynchronisation therapy (CRT). (Cardiol J 2007; 14: 224-231).