Perspectives on Pharmacological Prevention of Pacing Induced Heart Remodeling: Targeting Extracellular Matrix

Andrzej Tomasik

Right ventricle apical pacing causes dyssynchronous left ventricle contraction. Dyssynchrony leads to ventricular remodeling and an overt heart failure eventually. Experimental animal studies lend the evidence that dyssynchronous contraction is accompanied by tremendous derangement in extracellular compartment with altered collagen content, activity and expression of matrix metalloproteinases and their inhibitors. The capability of some therapeutic agents like angiotensin converting enzyme inhibitors, angiotensin receptor blockers or beta blockers to prevent postinfarction left ventricle remodeling should be considered as an anti-remodeling treatment in patients with implanted pacemakers and obligatory right ventricle pacing. We summarize the evidence and rationale for such preventive management.