Extended bipolar left ventricular pacing as a possible therapy for late electrical storm induced by cardiac resynchronization therapy

Asvestas, Dimitrios; Balasubramaniam, Richard; Sopher, Mark; Paisey, John; Babu, Girish

doi:10.1016/j.jelectrocard.2016.12.002

Cited by 3 publications

(9 citation statements)

References 9 publications

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“…Potential pro-arrhythmic effects of CRT has been described in several previous experiences [4][5][6][7][8][9] where biventricular and LV pacing are responsible of polymorphic and monomorphic VT although the mechanism of CRT-induced TV remains unclear. It has been observed as VT induced by CRT regarded patients with ischemic and non-ischemic cardiomyopathy.…”

Section: Discussionmentioning

confidence: 99%

“…The main reliable hypothesis seems to be that prolongation of the transmural dispersion of repolarization, by reversal of the activation sequence caused by LV epicardial pacing, might promote polymorphic TV [5,6] while others have indicated re-entry as the possible responsible mechanism of likely mechanism induced proarrhythmia [7]. Furthermore, the electrical storm induced by CRTpacing might be observed early after the implantation (3 days) [8] but a longer latent period (2 years) has been also described [9]. Independently to the delay of presentation, CRT-induced proarryhtmia is uncommon but life-threatening event after CRT implantation causing electrical storm and worsening of hemodynamic conditions.…”

Section: Introductionmentioning

confidence: 99%

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Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

Gonella,

Casile,

Menardi

et al. 2024

Preprint

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Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality and reverses left ventricular (LV) remodeling in heart failure patients with LV electrical dyssynchrony, induced proarrhythmia has been reported. The mechanism of CRT-induced proarrhythmia remains under debate. In this case report, a description of how a LV pacing induced polymorphic ventricular tachycardia immediately after the initiation of CRT has been reported. Changing the pacing configuration using a multipoint pacing stimulation, we can assume that VTs induced are related to the reentry mechanism facilitated by the unidirectional block. As a result, MPP pacing configuration near the scar area avoid the onset of a unidirectional block with the establishment of the reentry phenomenon thus avoiding induced VTs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

Gonella,

Casile,

Menardi

et al. 2024

Preprint

View full text Add to dashboard Cite

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“…Recent clinical studies have described CRT-induced arrhythmias,1, 2, 3, 4, 5 particularly in ICM patients1, 2, 3, 5 and when pacing near scar 4 . However, the underlying EP changes induced by pacing near scar that give rise to VT remained unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Multisite and endocardial pacing may offer feasible alternatives to conventional CRT in ICM patients. Multisite pacing allows pacing from multiple locations, maximizing resynchronization, and modifying these over time should they prove arrhythmogenic 3 . Endocardial pacing allows pacing anywhere within the endocardial surface, thus facilitating pacing within an optimal region while avoiding scar.…”

Section: Discussionmentioning

confidence: 99%

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Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis

et al. 2019

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BackgroundCardiac resynchronization therapy (CRT) increases the risk of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) when the left ventricular (LV) epicardial lead is implanted in proximity to scar.ObjectiveThe purpose of this study was to determine the mechanisms underpinning this risk by investigating the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT.MethodsImaging data from ICM patients (n = 24) undergoing CRT were used to create patient-specific LV anatomic computational models including scar morphology. Simulations of LV epicardial pacing at 0.2–4.5 cm from the scar were performed using EP models of chronic infarct and heart failure (HF). Dispersion of repolarization and the vulnerable window were computed as surrogates for VT risk.ResultsSimulations predict that pacing in proximity to scar (0.2 cm) compared to more distant pacing to a scar (4.5 cm) significantly (P <.01) increased dispersion of repolarization in the vicinity of the scar and widened (P <.01) the vulnerable window, increasing the likelihood of unidirectional block. Moreover, slow conduction during HF further increased dispersion (∼194%). Analysis of variance and post hoc tests show significantly (P <.01) reduced repolarization dispersion when pacing ≥3.5 cm from the scar compared to pacing at 0.2 cm.ConclusionIncreased dispersion of repolarization in the vicinity of the scar and widening of the vulnerable window when pacing in proximity to scar provides a mechanistic explanation for VT induction in ICM-CRT with lead placement proximal to scar. Pacing 3.5 cm or more from scar may avoid increasing VT risk in ICM-CRT patients.

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Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

Gonella,

Casile,

Menardi

et al. 2024

Diseases

View full text Add to dashboard Cite

Although cardiac resynchronization therapy (CRT) reduces morbidity and mortality and reverses left ventricular (LV) remodeling in heart failure patients with LV electrical dyssynchrony, induced proarrhythmia has been reported. The mechanism of CRT-induced proarrhythmia remains under debate. In this case report, a description of how LV pacing induced polymorphic ventricular tachycardia immediately after the initiation of CRT has been reported. By changing the pacing configuration using a multipoint pacing stimulation, we can assume that induced ventricular tachycardia is related to the reentry mechanism facilitated by the unidirectional block. As a result, a multipoint pacing (MPP) configuration near the scar area can avoid the onset of a unidirectional block with the establishment of the reentry phenomenon, thus avoiding induced VTs.

show abstract

Extended bipolar left ventricular pacing as a possible therapy for late electrical storm induced by cardiac resynchronization therapy

Cited by 3 publications

References 9 publications

Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis

Electrical Storm Induced by Cardiac Resynchronization: Efficacy of the Multipoint Pacing Stimulation

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