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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