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Vol. 7. Núm. G.
Estimulación cardiaca con marcapasos: fisiopatología, uso clínico, seguimiento y complicaciones
Páginas 69G-81G (Octubre 2007)
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Vol. 7. Núm. G.
Estimulación cardiaca con marcapasos: fisiopatología, uso clínico, seguimiento y complicaciones
Páginas 69G-81G (Octubre 2007)
Estimulación cardiaca con marcapasos
Acceso a texto completo
Selección del modo de estimulación en las bradiarritmias. Controversias sobre la indicación del modo AAI o el modo DDD en la enfermedad del nódulo sinusal y sobre la utilización del modo VDD en el bloqueo auriculoventricular
Pacing Mode Selection for Bradyarrhythmias. Controversies Concerning Indications for the AAI Mode Versus the DDD Mode in Sick Sinus Syndrome and on the Use of the VDD Mode for Atrioventricular Block
Visitas
117
Claudio Ledesma Garcíaa,
Autor para correspondencia
cledesmagar@yahoo.es

Correspondencia: Dr. C. Ledesma García. Unidad de Arritmias. Servicio de Cardiología. Hospital Clínico Universitario de Salamanca. Paseo San Vicente, 58-182. 37007 Salamanca. España.
, Ramón García Calabozob, Agustín Pastor Fuentesc
a Unidad de Arritmias. Hospital Clínico Universitario de Salamanca. Salamanca. España
b Servicio de Cardiología. Hospital de León. León. España
c Servicio de Cardiología. Hospital Universitario de Getafe. Madrid. España
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Desde que en los años cincuenta se introdujo la estimulación cardiaca como tratamiento de las bradiarritmias cardiacas, el marcapasos cardiaco implantable ha sufrido una progresiva sofisticación y un continuo intento de aproximación, en su funcionamiento, a la fisiología normal del corazón. Al mismo tiempo, las indicaciones para implantación de un marcapasos han ido variando durante los últimos años y se han consensuado por expertos en documentos (Guías de Actuación Clínica) basados en la experiencia y en el índice de evidencia existente para cada indicación. A pesar de ello, siguen evidenciándose discrepancias entre estas indicaciones claramente establecidas y el modo de estimulación utilizado para el tratamiento de las bradiarritmias sintomáticas. Probablemente, los dos modos que ofrecen más discrepancia en su utilización sean los modos AAI y VDD. En este capítulo se realiza una revisión de las indicaciones de estimulación cardiaca, resaltando las nuevas evidencias existentes en cuanto al modo de estimulación, lugar de estimulación y efectos indeseables de la estimulación cardiaca. Asimismo, se analiza la controversia existente sobre la estimulación AAI y la estimulación DDD en la enfermedad del nódulo sinusal y la utilización del modo VDD en el bloqueo auriculoventricular.

Palabras clave:
Bradiarritmias
Estimulación con marcapasos
Selección del modo de estimulación

Since cardiac pacing was introduced for the treatment of cardiac bradyarrhythmias in the 1950s, implantable cardiac pacemakers have become increasingly sophisticated and there have been continuous attempts to enable them to approximate more closely the normal physiologic functioning of the heart. At the same time, indications for pacemaker implantation have been changing in recent years and a number of expert consensuses have been reached. These are contained in documents (i.e., clinical practice guidelines) based on clinical trails and on the current level of evidence for each indication. Nevertheless, there continue to be demonstrable differences between clearly established recommendations and the pacing modes used for treating symptomatic bradyarrhythmias. Probably, the two pacing modes exhibiting the greatest difference in practice are the AAI and VDD modes. This article contains a review of indications for cardiac pacing, with an emphasis on newly revealed data on pacing modes, pacing sites, and the undesirable side effects of cardiac pacing. In addition, there is a discussion of current controversies about the AAI mode versus the DDD mode in sick sinus syndrome and about use of the VDD mode for atrioventricular block.

Key words:
Bradyarrhythmias
Pacemakers
Pacing mode selection
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