Einzelzellbiologie

Abstrakt

Perspectives on the pharmacological prevention of pacemaker-induced cardiac remodeling: targeting the extracellular matrix

Andrzej Tomasik

Stimulation of the right ventricle at the apex of the heart induces dyssynchronous contraction of the left ventricle. This dyssynchrony leads to ventricular remodeling and eventually to overt heart failure. Animal studies demonstrate that dyssynchronous contraction is associated with tremendous disruption of the extracellular compartment, resulting in altered collagen content, activity and expression of matrix metalloproteinases and their inhibitors. The ability of some therapeutics such as ACE inhibitors, angiotensin receptor blockers or beta-blockers to prevent left ventricular remodeling after infarction should be considered as anti-remodeling treatment in patients with implanted pacemakers and mandatory right ventricular stimulation. We summarize the evidence and rationale for such preventive treatment.