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
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