Biventricular Pacing Attenuates T‐Wave Alternans and T‐Wave Amplitude Compared to Other Pacing Modes

Anh, Daejoon; Srivatsa, Uma N.; Bui, Hanh My; Vasconcellos, S.; Narayan, Sanjiv M.

doi:10.1111/j.1540-8159.2008.01074.x

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…Two previous studies compared the effects of different pacing modes on the incidence of TWA in patients with low LV function, and Ehrlich, et al found a high level of concordance between TWA test results obtained during RAP and results obtained under other pacing modes; they also reported that TWA assessment seems not to be influenced by BVP in congestive heart failure patients 16) . Anh, et al reported that BVP attenuates TWA in tandem with reduced T-wave magnitude and that, in patients with baseline QRS prolongation, TWA during RVP predicts events more effectively than does BVP or RAP 15) . Results of the present study were not concordant with results of these previously reported studies 15,16) .…”

Section: Discussionmentioning

confidence: 99%

“…Anh, et al reported that BVP attenuates TWA in tandem with reduced T-wave magnitude and that, in patients with baseline QRS prolongation, TWA during RVP predicts events more effectively than does BVP or RAP 15) . Results of the present study were not concordant with results of these previously reported studies 15,16) . The reason for the discrepancy is unclear; however it is possible that underlying heart disease, heart failure status, and/or timing of the TWA measurement after implantation of the CRT device influenced the results.…”

Section: Discussionmentioning

confidence: 99%

“…Microvolt T-wave alternans (TWA) has been shown to mark temporal dispersion of repolarization and to predict ventricular arrhythmia associated with structural heart disease [9][10][11][12][13] . However, only a few studies demonstrating the effects of various pacing modes on the incidence of TWA have been reported, and the results remain controversial [14][15][16][17] .…”

Section: Introductionmentioning

confidence: 99%

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Influence of Pacing Modes on Microvolt T-Wave Alternans

Hashimoto

Watanabe

Kasamaki

et al. 2014

Nichidai Igaku Zasshi

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Objective: Cardiac resynchronization therapy (CRT) is known to be effective for left ventricular dysfunction associated with left bundle branch block. However, CRT does not necessarily decrease the risk of sudden cardiac death. Recent studies have shown that epicardial left ventricular pacing may lead to prolongation of the QT interval and the development of torsades de pointes. Microvolt T-wave alternans (TWA) has been associated with increased susceptibility to ventricular tachyarrhythmias. We compared the influence of right atrial pacing, right ventricular pacing, left ventricular pacing and biventricular pacing (RAP, RVP, LVP and BVP) on TWA.Methods: TWA was measured per pacing mode during incremental pacing from 70 to 120 bpm in 18 CRT patients with a mean ejection fraction of 32±5%. TWA was considered positive if alternans voltage (Valt)＞1.9 μV and alternans ratio (AR)＞3.0 were observed for at least 1 minute. The incidence of TWA is reported as the percentage of impulse applications during which it was observed.Results: TWA was observed as follows: BVP, 73%; RVP, 50%; LVP, 60%; and RAP, 60%. Mean Valt (μV) was 2. 44±0.35, 0.36±0.11, 1.44±0.65, and 1.95±0.45, respectively (P＜0.01 BVP vs. RVP). Mean alternans ratio during BVP, RVP, LVP, and RAP was 8.21±2.4, 4.28±1.3, 5.66±2.3, and 7.36±2.0, respectively (P＜0.05 BVP vs. RVP).Conclusion: BVP may increase the temporal inhomogeneity of ventricular repolarization, which may lead to the development of ventricular tachyarrhythmia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Pacing Modes on Microvolt T-Wave Alternans

Hashimoto

Watanabe

Kasamaki

et al. 2014

Nichidai Igaku Zasshi

View full text Add to dashboard Cite

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“…The results of previous investigations into this relationship in humans with heart failure have been inconsistent (1,7). Thus, further research is needed to elucidate the relationship between TWA and other indexes of repolarizaiton, including the T-wave amplitude and area.…”

Section: Min (Peak Effect) After the Injection Of Isoproterenolmentioning

confidence: 93%

“…Recent studies (1,5) in humans with heart failure have shown that changes in the T wave amplitude and area could be related to alterations in the repolarization sequence. Thus, the changes in the T wave amplitude and area observed in FVB mice could also be related to the alterations of the repolarization sequence induced by adrenergic stimulation and associated changes in CLs.…”

Section: Min (Peak Effect) After the Injection Of Isoproterenolmentioning

confidence: 98%

Adrenergic stimulation promotes T-wave alternans and arrhythmia inducibility in a TNF-α genetic mouse model of congestive heart failure

Shusterman

McTiernan

Goldberg

et al. 2010

American Journal of Physiology-Heart and Circulatory Physiology

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T-wave alternans (TWA) is a proarrhythmic repolarization instability that is common in congestive heart failure (CHF). Although transgenic mice are commonly used to study the mechanisms of arrhythmogenesis in CHF, little is known about the dynamics of TWA in these species. We hypothesized that TWA is present in a TNF-alpha model of CHF and can be further promoted by adrenergic stimulation. We studied 16 TNF-alpha mice and 12 FVB controls using 1) in vivo intracardiac electrophysiological testing and 2) ambulatory telemetry during 30 min before and after an intraperitoneal injection of isoproterenol. TWA was examined using both linear and nonlinear filtering applied in the time domain. In addition, changes in the mean amplitude of the T wave and area under the T wave were computed. During intracardiac electrophysiological testing, none of the animals had TWA or inducible arrhythmias before the injection of isoproterenol. After the injection, sustained TWA and inducible ventricular tachyarrhythmias were observed in TNF-alpha mice but not in FVB mice. In ambulatory telemetry, before the isoproterenol injection, the cardiac cycle length (CL) was longer in TNF-alpha mice than in FVB mice (98 +/- 9 and 88 +/- 3 ms, P = 0.04). After the injection of isoproterenol, the CL became 8% and 6% shorter in TNF-alpha and FVB mice (P < 10(-4)); however, the 2% difference between the groups in the magnitude of CL changes was not significant. In TNF-alpha mice, the magnitude of TWA was 1.5-2 times greater than in FVB mice both before and after the isoproterenol injection. The magnitude of TWA increased significantly after the isoproterenol injection compared with the baseline in TNF-alpha mice (P = 0.003) but not in FVB mice. The mean amplitude of the T wave and area under the T wave increased 60% and 80% in FVB mice (P = 0.006 and 0.009) but not in TNF-alpha mice. In conclusion, TWA is present in a TNF-alpha model of CHF and can be further promoted by adrenergic stimulation, along with the enhanced susceptibility for ventricular arrhythmias.

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To the Editor

Madias

2008

Heart Rhythm

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Biventricular Pacing Attenuates T‐Wave Alternans and T‐Wave Amplitude Compared to Other Pacing Modes

Cited by 20 publications

References 33 publications

Influence of Pacing Modes on Microvolt T-Wave Alternans

Influence of Pacing Modes on Microvolt T-Wave Alternans

Adrenergic stimulation promotes T-wave alternans and arrhythmia inducibility in a TNF-α genetic mouse model of congestive heart failure

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