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Stritecky J, Kremlacek J, Hanus J, Haman L, Stritecka H, Simka J, Parizek P. Capture threshold of bipolar and unipolar pacing of left ventricle via coronary sinus branch: longitudinal study. Front Cardiovasc Med 2023; 10:1096538. [PMID: 37288262 PMCID: PMC10242161 DOI: 10.3389/fcvm.2023.1096538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/18/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The aim of this paper is to first monitor the changes in the capture threshold of endovascularly placed leads for left ventricle pacing, second to compare the pacing configurations, and third to verify the effect of Steroid elution for endovascular leads. Sample and Method The study included 202 consecutive single centre patients implanted with the Quartet™ lead (St. Jude Medical). The capture threshold and related lead parameters were tested during implantation, on the day of the patient's discharge, and 3, 9, and 15 months after implantation. The electrical energy corresponding to the threshold values for inducing ventricular contraction was recorded for subgroups of patients with bipolar and pseudo-unipolar pacing vectors and electrodes equipped with and without a slow-eluting steroids. The best setting for the resynchronization effect was generally chosen. Capture threshold was taken as a selection criterion only if there were multiple options with (expected) similar resynchronization effect. Results and Discussion The measurements showed that the ratio of threshold energies of UNI vs. BI was 5× higher (p < 0.001) at implantation. At the end of the follow-up, it dropped to 2.6 (p = 0.012). The steroid effect in BI vectors was caused by a double capture threshold in the NSE group compared to the SE group (p < 0.001), increased by approximately 2.5 times (p < 0.001). The study concludes that after a larger initial increase in the capture threshold, the leads showed a gradual increase in the entire set. As a result, the bipolar threshold energies increase, and the pseudo-unipolar energies decrease. Since bipolar vectors require a significantly lower pacing energy, battery life of the implanted device would improve. When evaluating the steroid elution of bipolar vectors, we observe a significant positive effect of a gradual increase of the threshold energy.
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Affiliation(s)
- Jakub Stritecky
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Josef Hanus
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hana Stritecka
- Department of Military Internal Medicine and Military Hygiene, Faculty of Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Jakub Simka
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Parizek
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Kutyifa V, Jame S, Wang PJ, Musat D, Jones P, Wehrenberg S, Stein K. True bipolar or extended bipolar left ventricular pacing is associated with better survival in cardiac resynchronization therapy patients. Pacing Clin Electrophysiol 2020; 43:412-417. [DOI: 10.1111/pace.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 01/18/2020] [Accepted: 02/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Valentina Kutyifa
- Department of MedicineUniversity of Rochester Medical Center Rochester New York
| | - Sina Jame
- Cardiology DepartmentUniversity of Michigan Ann Arbor Michigan
| | - Paul J. Wang
- Cardiovascular MedicineStanford University Stanford California
| | - Dan Musat
- CardiologyValley Hospital Ridgewood New Jersey
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Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, Porter B, Niederer S, Yao C, Rinaldi CA. Variation in activation time during bipolar vs extended bipolar left ventricular pacing. J Cardiovasc Electrophysiol 2018; 29:1675-1681. [PMID: 30106206 DOI: 10.1111/jce.13714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is typically delivered via quadripolar leads that allow stimulation using either true bipolar pacing, where stimulation occurs between two electrodes (BP) on the quadripolar lead, or extended bipole (EBP) left ventricular (LV) pacing, with the quadripolar electrodes and right ventricular coil acting as the cathode and anode, respectively. True bipolar pacing is associated with reductions in mortality and it has been postulated that these differences are the result of enhanced electrical activation. MATERIALS AND METHODS Patients undergoing a CRT underwent an electrocardiographic imaging study where electrical activation data were recorded while different LV pacing vectors were temporarily programmed. RESULTS There were no differences in the total electrical activation times or dispersion of electrical activation between biventricular pacing with bipolar or corresponding EBP LV vector configurations (left ventricular total activation time [LVtat] BP 74.70 ± 18.07 vs EBP 72.4 ± 22.64; P = 0.45). When dichotomized according to etiology, no difference was observed in the activation time with either BP or EBP pacing (LVtat BP ischemic cardiomyopathy 72.2 ± 17.4 vs BP dilated cardiomyopathy 79.9 ± 18.9; P = 0.38). CONCLUSIONS Bipolar pacing alters the mechanical activation sequence of the LV and is associated with reductions in all-cause mortality. It has been postulated these benefits derive from improvements in electromechanical activation of the LV. Our study would suggest that true bipolar pacing does not necessarily result in more favorable activation of the LV or improved electrical resynchronization and other mechanisms should be explored.
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Affiliation(s)
- Benjamin J Sieniewicz
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Tom Jackson
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Simon Claridge
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Helder Pereira
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Justin Gould
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Baldeep Sidhu
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Bradley Porter
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - Steve Niederer
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Cheng Yao
- CardioInsight Technologies, Medtronic, Minneapolis, Minnesota
| | - Christopher A Rinaldi
- Department of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.,Cardiology Department, Guys and St Thomas' NHS Foundation Trust, London, UK
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Jamé S, Kutyifa V, Aktas MK, McNitt S, Polonsky B, Al-Ahmad A, Zareba W, Moss A, Wang PJ. Bipolar left ventricular pacing is associated with significant reduction in heart failure or death in CRT-D patients with LBBB. Heart Rhythm 2016; 13:1468-74. [PMID: 26961303 DOI: 10.1016/j.hrthm.2016.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND There are limited data on the significance of left ventricular (LV) lead pacing polarity to predict clinical outcomes. OBJECTIVES We aimed to determine the association between the LV lead pacing polarity for heart failure (HF) or death and ventricular tachyarrhythmias (VTA) in patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy), receiving a cardiac resynchronization therapy device with implanted cardioverter-defibrillator (CRT-D). METHODS We retrospectively analyzed LV pacing polarity. Patients with LV bipolar leads paced between LV ring and LV tip were identified as True Bipolar, while those with LV bipolar leads paced between LV tip or LV ring and right ventricular coil or unipolar leads were identified as Unipolar/Extended Bipolar. Kaplan-Meier survival analyses and multivariate Cox proportional hazards regression models were used. RESULTS Of the 969 patients, 421 had True Bipolar pacing while the remainder (n = 548) had Unipolar/Extended Bipolar pacing. Among patients with left bundle branch block (LBBB), True Bipolar pacing was associated with lower cumulative incidence of death (P = .022) and HF/death (P = .046) compared to those with Unipolar/Extended Bipolar LV pacing. After adjustment for clinical covariates, bipolar LV pacing in LBBB patients was associated with 54% lower risk for death (HR: 0.46; 95% CI: 0.24-0.88; P = .020) and 32% lower risk for HF/death (HR: 0.68; 95% CI: 0.46-1.00; P = .048) compared to Unipolar/Extended Bipolar LV pacing, but not in those with non-LBBB. No association was seen with risk of ventricular tachyarrhythmia. CONCLUSION True Bipolar LV pacing configuration is associated with a significantly lower risk of HF/death and all-cause mortality in CRT-D patients with LBBB.
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Affiliation(s)
- Sina Jamé
- Stanford University, Stanford, California
| | | | - Mehmet K Aktas
- University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- University of Rochester Medical Center, Rochester, New York
| | | | | | | | - Arthur Moss
- University of Rochester Medical Center, Rochester, New York
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