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Osca J, Francisco-Pascual J, Martínez-Basterra J, Martínez JG, Reis H, Oliveira M, Campos B, Balaguer J, Rubio J, Pavón-Jiménez R, Hernández J, Ormaetxe JM, Zamorano JL, Santamaría P, Alzueta J. Response rate in cardiac resynchronization therapy patients implanted with a left ventricular quadripolar lead and the MultiPoint™ pacing feature early activated. QUARTO III. Eur J Clin Invest 2023; 53:e13935. [PMID: 36504276 DOI: 10.1111/eci.13935] [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: 09/26/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although cardiac resynchronization therapy (CRT) is beneficial in most heart failure patients, up to 40% do not respond to CRT. It has been suggested that multipoint left ventricle pacing (MPP) would increase the response rate. AIM To assess the CRT response rate at 6 months in patients implanted with a CRT device with the MPP feature activated early after the implant. METHODS This was a multicentre, prospective, open-label and non-randomized study. The primary endpoint was response to biventricular pacing defined as >15% relative reduction in left ventricular end-systolic volume (LVESV) comparing echocardiography measurements performed at baseline and 6 months by a core laboratory. Among secondary endpoints the combined endpoint of mortality or all-cause hospitalizations was evaluated. Primary study endpoint and clinical outcomes were compared to a Quarto II control cohort. RESULTS Totally, 105 patients were included. The response rate was 64.6% (97.5% lower confidence bound 53%). Mean relative reduction in LVESV was 25.3%, and mean absolute increase in LVEF was 9.4%. The subjects with device programmed using anatomical approach showed a trend towards higher responder rate than those using the electrical approach (72% vs. 61.1%, p = 0.32). Finally, the combined incidence of mortality and or all-cause hospitalizations at 6 month was 12.4%. CONCLUSIONS Early activation of MPP was not associated to an advantage increasing echocardiography responders to CRT at 6 months of follow-up. Nevertheless, patients programmed using widest pacing cathodes had a numerically higher responder rate. Finally, early activation of MPP was associated to a low incidence of clinical endpoints at 6 months of follow-up.
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Affiliation(s)
- Joaquín Osca
- Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Jaume Francisco-Pascual
- Servicio de Cardiología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, CIBER-CV, Barcelona, Spain
| | | | | | | | | | - Bieito Campos
- Hospital Universitari Arnau de Vilanova de Lleida, Barcelona, Spain
| | - Javier Balaguer
- Hospital General Universitario de Guadalajara, Guadalajara, Spain
| | - Jerónimo Rubio
- Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Julio Hernández
- Hospital Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | | | | | - Javier Alzueta
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Pfeffer C, Fryer M, Quah JX, Dayananda N, Tung M. Electrogram analysis to detect cathodal and anodal capture in left ventricular cardiac resynchronization pacing leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 45:165-175. [PMID: 34879152 DOI: 10.1111/pace.14403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 11/30/2022]
Abstract
AIMS Our study analyzed cardiac electrograms (EGMs) to identify characteristics for detecting cathodal, anodal, or cathodal-anodal (simultaneous) capture in left ventricular (LV) quadripolar pacing leads of cardiac resynchronization therapy (CRT) patients. The relationship between these EGM characteristics and the electrocardiogram (ECG) was also examined. METHODS We performed a retrospective analysis of 54 bipolar pacing configurations across 9 patients with implanted CRT devices and quadripolar leads who had undergone a 12 lead ECG optimization. Three pacing tests (cathode unipolar, anode unipolar, and bipolar) per bipolar pair were performed, examining ECG and EGM morphology changes accompanying each test and any transitions of morphology or amplitude during voltage stepdown. RESULTS During the cathode and anode unipolar pacing tests, the EGM was biphasic (negative/positive) or monophasic (positive) in 52/53 (98%), and biphasic (positive/negative) or monophasic (negative) in 50/51 (98%) respectively. During bipolar LV capture threshold testing, 30 bipolar pairs displayed a sudden increase in EGM amplitude (median 9.4mV, interquartile range [7 to 14mV]) when transitioning from cathodal-anodal capture to cathodal or anodal capture. 90% of these EGM transitions had a corresponding simultaneous change in ECG, while 10% had no ECG changes. Two patients demonstrated "quad-site" capture on their quadripolar lead with multipoint pacing enabled and cathodal-anodal capture from each stimulus. CONCLUSION EGM characteristics during LV pacing tests can reliably detect cathodal, anodal, or cathodal-anodal capture, with greater sensitivity than 12 lead ECG changes. Integration of EGM analysis into routine CRT device follow up can be performed easily and may have implications for CRT efficacy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Cameron Pfeffer
- Electrophysiology, Abbott Laboratories, Building 1, Ground Floor, Freeway Office Park, 2728 Logan Road, Eight Mile Plains, Brisbane, Queensland, 4113, Australia
| | - Michael Fryer
- Cardiology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Jing Xian Quah
- Cardiology, Flinders University College of Medicine and Public Health, Bedford Park, South Australia, Australia
| | - Naresh Dayananda
- Cardiology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Matthew Tung
- Cardiology, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
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Guandalini GS, Hyman MC. Worsening Cardiomyopathy Despite Biventricular Pacing. JAMA Cardiol 2021; 6:1338-1339. [PMID: 34379073 DOI: 10.1001/jamacardio.2021.2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Gustavo S Guandalini
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew C Hyman
- Section of Cardiac Electrophysiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Boscamp NS, Liberman L, Silver ES. Anodal stimulation in pediatric patients with permanent epicardial ventricular pacemakers. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1593-1598. [PMID: 34287953 DOI: 10.1111/pace.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 06/08/2021] [Accepted: 07/18/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES We aimed to measure the frequency and factors associated with anodal stimulation in a pediatric population with epicardial pacing leads. BACKGROUND In bipolar pacemakers, capture of the myocardium typically occurs at the cathode. However, AS with capture at the anode has been described. This has not been described in epicardial pacemakers. METHODS Retrospective data were collected from patients ≤ 21 years of age with permanent bipolar epicardial ventricular pacemakers from 1/2017 to 1/2018. AS was defined as a clear change on surface ECG in at least one of the 12 leads assessed by two blinded pediatric electrophysiologists. RESULTS Twenty-four bipolar leads in 23 patients were included in the study. One patient had both biventricular leads tested. Median age was 7.1 years (IQR 5.0-10.9), weight was 20.9 kg (IQR 16.5-33.5), and 65% were male. Testing was performed at a median of 2.8 years (IQR 1.6-6.1) after implant. Congenital heart disease was present in 57%. Complete heart block was the pacemaker indication in 78%. AS was identified in 16/24 (67%) of leads tested. Identification of AS was associated with presence of congenital heart disease (p = 0.004) and 3DD between electrodes (p = 0.04). CONCLUSIONS AS is common in pediatric patients and was associated with a history of congenital heart disease and greater estimated 3DD between electrodes. The prevalent nature of AS may allow clinicians to utilize existing pacemakers as multisite pacing systems.
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Affiliation(s)
- Nicholas S Boscamp
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
| | - Eric S Silver
- Division of Pediatric Cardiology, Morgan Stanley Children's Hospital of New York, Columbia University Irving Medical Center, New York, New York, USA
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Dell'Era G, De Vecchi F, Prenna E, Devecchi C, Degiovanni A, Malacrida M, Magnani A, Occhetta E, Marino P. Feasibility of cathodic-anodal left ventricular stimulation for alternative multisite pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:597-602. [DOI: 10.1111/pace.13344] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/23/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Gabriele Dell'Era
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
| | | | - Eleonora Prenna
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
| | | | - Anna Degiovanni
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
| | | | - Andrea Magnani
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
| | - Eraldo Occhetta
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
| | - Paolo Marino
- Department of Cardiology; University Hospital ‘Maggiore della Carita`’; Novara Italy
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Niazi I, Baker J, Corbisiero R, Love C, Martin D, Sheppard R, Worley SJ, Varma N, Lee K, Tomassoni G. Safety and Efficacy of Multipoint Pacing in Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:1510-1518. [DOI: 10.1016/j.jacep.2017.06.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/23/2017] [Accepted: 06/26/2017] [Indexed: 10/18/2022]
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Occhetta E, Dell'Era G, Giubertoni A, Magnani A, Rametta F, Blandino A, Magnano V, Malacrida M, Marino P. Occurrence of simultaneous cathodal-anodal capture with left ventricular quadripolar leads for cardiac resynchronization therapy: an electrocardiogram evaluation. Europace 2017; 19:596-601. [PMID: 28431053 DOI: 10.1093/europace/euw046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/04/2016] [Indexed: 10/13/2023] Open
Abstract
AIMS The occurrence of left ventricular (LV) anodal activation during pacing with modern multipolar cardiac resynchronization therapy (CRT) systems has never been reported. The aim of our study was to demonstrate, by means of electrocardiogram (ECG) analysis, the occurrence of simultaneous cathodal-anodal LV capture with quadripolar LV leads. METHODS AND RESULTS We studied 10 first-time recipients of a CRT device equipped with a quadripolar LV lead. During follow-up, standard supine 12-lead ECGs were obtained in available cathode-to-anode LV pacing configurations with a pulse amplitude equal to twice the pacing threshold. The occurrence of simultaneous cathodal-anodal LV capture was defined as the presence of variations in electrocardiographic ventricular activation (EVA) when the distal tip (cathode)-to-device can (anode) pacing configuration was compared with the distal tip (cathode)-to-proximal ring (anode) configuration. In eight patients, we found differences in EVA when different LV sites were paced through the unipolar LV tip and unipolar LV ring configurations. In these patients, a difference in EVA was detected in 61.5% (59 of 96) of the ECG leads (marked difference in 31.3%, slight difference in 30.2%). Changes in EVA between unipolar tip-to-can and bipolar tip-to-ring pacing that were suggestive of cathodal-anodal LV capture were found in six patients. In these patients, a total of 30 (41.7%) ECG leads showed a difference in EVA (marked difference in 20.8%, slight difference in 20.8%). CONCLUSION In our experience, additional anodal capture by the proximal LV ring during LV pacing is provable in most recipients of a resynchronization device equipped with a multipolar LV lead.
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Affiliation(s)
- Eraldo Occhetta
- Department of Cardiology, University Hospital 'Maggiore della Carità', Corso Mazzini 18, 28100 Novara, Italy
| | - Gabriele Dell'Era
- Department of Cardiology, University Hospital 'Maggiore della Carità', Corso Mazzini 18, 28100 Novara, Italy
| | - Ailia Giubertoni
- Department of Cardiology, University Hospital 'Maggiore della Carità', Corso Mazzini 18, 28100 Novara, Italy
| | - Andrea Magnani
- Department of Cardiology, University Hospital 'Maggiore della Carità', Corso Mazzini 18, 28100 Novara, Italy
| | | | | | | | | | - Paolo Marino
- Department of Cardiology, University Hospital 'Maggiore della Carità', Corso Mazzini 18, 28100 Novara, Italy
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8
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Gu M, Hua W, Fan XH, Ding LG, Wang J, Niu HX, Xu C, Jin H, Zhang S. Short-Term Availability of Viable Left Ventricular Pacing Sites with Quartet™ Quadripolar Leads. Med Sci Monit 2017; 23:767-773. [PMID: 28188984 PMCID: PMC5317280 DOI: 10.12659/msm.902743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Whether quadripolar leads can provide sufficient viable left ventricular pacing sites (LVPSs) for device optimization and multipoint pacing remains unclear. This study aimed to evaluate the acute and 3-month availability of viable LVPSs provided by a quadripolar LV pacing lead. MATERIAL AND METHODS A single-center cohort study evaluated consecutive patients who underwent a CRT implant with the QuartetTM LV lead under local guidelines. The availability of viable LVPSs was assessed at the pre-discharge and 3-month follow-up visit. Bipolar lead configurations, which served as the control group, were modeled by eliminating the 2 proximal electrodes on the Quartet™ LV lead. RESULTS A total of 24 patients were enrolled and finished 3-month follow-up. The mean follow-up period was 93±3 days. At pre-discharge, the Quartet™ LV lead provided more viable LVPSs compared with the bipolar equivalents (median 3 [IQR 2-4] vs. median 2 [IQR 1-2], P<0.001). The percentage of patients with at least 1, 2, 3, and 4 viable LVPSs were 100% (24/24), 91.7% (22/24), 58.3% (14/24), and 33.3% (8/24) for Quartet™ leads and 91.7% (22/24), 70.8% (17/24), 0% (0/24), and 0% (0/24) for bipolar lead configurations, respectively. The median and IQR values of viable LVPSs provided by the Quartet™ LV lead remained the same (3 [IQR 2-4]) between pre-discharge and 3-month follow-up (P=0.45). CONCLUSIONS Compared with the bipolar equivalent, QuartetTM LV lead provides more viable LVPSs and opportunities for CRT optimization and multipoint LV pacing. The number of LVPSs provided by Quartet™ leads remained unchanged between pre-discharge and 3-month follow-up.
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Affiliation(s)
- Min Gu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Wei Hua
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Xiao-Han Fan
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Li-Gang Ding
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Jing Wang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Hong-Xia Niu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Cong Xu
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Han Jin
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
| | - Shu Zhang
- The Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (mainland)
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Kutyifa V. Reply to the Editor- Bipolar left ventricular pacing is associated with significant reduction in heart failure or death in CRT-D patients with LBBB. Heart Rhythm 2016; 13:e327-e328. [PMID: 27503478 DOI: 10.1016/j.hrthm.2016.08.015] [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: 08/01/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Valentina Kutyifa
- Heart Research Follow-up Program University of Rochester Medical Center Rochester, New York.
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Oyama MA, Hezzell MJ, Laughlin DS, Thorn CL, Kraus MS, Gelzer AR. Anodal stimulation in two dogs with transvenous permanent bipolar pacemakers. J Vet Cardiol 2016; 18:398-404. [PMID: 27613649 DOI: 10.1016/j.jvc.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/05/2016] [Accepted: 07/24/2016] [Indexed: 11/20/2022]
Abstract
Management of symptomatic bradyarrhythmias such as complete atrioventricular block often involves permanent implantation of a transvenous pacemaker. Both during and after implantation, the operator can telemetrically assess and adjust a variety of electrical parameters associated with the pacemaker function in order to optimize the sensitivity, reliability, and power consumption of the device. Herein, we report an unexpected change in the paced electrocardiographic QRS complex morphology in two dogs undergoing bipolar pacing associated with changes in the pacemaker output amplitude settings first detected during threshold testing. The exclusivity of the electrocardiographic changes solely on pacemaker output settings, consistency between the surface electrocardiogram and ventricular endocardial electrogram, and resolution of this phenomenon when dogs were re-programmed to unipolar pacing is consistent with depolarization of the ventricular myocardium by the anodal electrode of the pacing lead at high pacemaker amplitudes. Anodal stimulation is a potential cause of varying QRS complex morphology witnessed during pacemaker evaluation and interrogation.
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Affiliation(s)
- M A Oyama
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA.
| | - M J Hezzell
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA
| | - D S Laughlin
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA
| | - C L Thorn
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA
| | - M S Kraus
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA
| | - A R Gelzer
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, 3900 Delancey St., Philadelphia, PA 19104, USA
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Toquero Ramos J, Sánchez García M, Ruíz Bautista L, Castro Urda V, Alyoun Alonso S, Fernández Lozano I. Estimulación multipunto mediante captura anódica del ventrículo izquierdo a través de un electrodo cuadripolar: evaluación hemodinámica no invasiva. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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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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13
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BENEZET-MAZUECOS JUAN, IGLESIAS JOSÉANTONIO, RUBIO JOSÉMANUEL, FARRÉ JERÓNIMO. Anodal Stimulation in Biventricular Pacing: Unrecognized and Misinterpreted Phenomenon. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1485-8. [DOI: 10.1111/pace.12650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 03/14/2015] [Accepted: 04/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- JUAN BENEZET-MAZUECOS
- Cardiology Department; Fundación Jiménez Díaz - IDC, Universidad Autónoma de Madrid; Madrid Spain
| | - JOSÉ ANTONIO IGLESIAS
- Cardiology Department; Fundación Jiménez Díaz - IDC, Universidad Autónoma de Madrid; Madrid Spain
| | - JOSÉ MANUEL RUBIO
- Cardiology Department; Fundación Jiménez Díaz - IDC, Universidad Autónoma de Madrid; Madrid Spain
| | - JERÓNIMO FARRÉ
- Cardiology Department; Fundación Jiménez Díaz - IDC, Universidad Autónoma de Madrid; Madrid Spain
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Huang JL, Lin YJ, Hung YW, Hsieh YC, Cheng CM, Wang KY. Preventing phrenic nerve stimulation by a patch insulation in an intact swine heart model. PLoS One 2014; 9:e102608. [PMID: 25033271 PMCID: PMC4102517 DOI: 10.1371/journal.pone.0102608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 06/04/2014] [Indexed: 12/04/2022] Open
Abstract
Introduction Phrenic nerve stimulation (PNS) could be prevented by a silastic patch over the epicardial lead. We studied the effects in preventing PNS by placing a silastic patch directly over an epicardial lead or placing a graft around the phrenic nerve (PN). Methods and Results Fourteen Lanyu swine were enrolled. A bipolar lead was placed epicardially on the left ventricle (LV) inferior to the PN. An implantable cardioverter-defibrillator (ICD) lead was placed into the right ventricle (RV). The maximal influential distance (MID) was measured under 3 pacing configurations to express the influential electrical field on the PN. The threshold of the LV and PN were evaluated epicardially. Then, PTFE patches of different sizes (10×10 mm, 20×20 mm and 30×30 mm) were placed between the LV lead and PN to study the rise in PN threshold in 7 swine. On the other hand, the PN were surrounded by a PTFE graft of different lengths (10 mm, 20 mm, and 30 mm) in the remaining 7 swine. LV-bipolar pacing showed the shortest MID when compared to the other 2 unipolar pacing configurations at pacing voltage of 10 V. The patch was most effective in preventing PNS during LV-bipolar pacing. PNS was prevented under all circumstances with a larger PTFE patch (30×30 mm) or long graft (30 mm). Conclusions PNS was avoided by placing a PTFE patch over the LV lead or a graft around the PN despite pacing configurations. Hence if PNS persisted during CRT implantation, a PTFE patch on the LV lead or a graft around the PN could be considered.
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Affiliation(s)
- Jin-Long Huang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
- * E-mail:
| | - Yenn-Jiang Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Wen Hung
- Department of Education and Research, Taichung Veterans General Hospital, Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yu-Cheng Hsieh
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chien-Ming Cheng
- Division of Cardiology, Department of Medicine, Feng Yuan Hospital of the Ministry of Health and Welfare, Executive Yuan, Taichung City, Taiwan (R.O.C)
| | - Kuo-Yang Wang
- Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan
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HERWEG BENGT, BAROLD SSERGE. Three-Step Electrocardiographic Evaluation of Cardiac Resynchronization. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:249-52. [DOI: 10.1111/j.1540-8159.2011.03285.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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