Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization: Does resynchronization therapy pose a risk for patients predisposed to long QT or torsade de pointes?

Medina‐Ravell, Victor; Yan, Guoquan; Antzelevitch, Charles; Lankipalli, Ramarao S.; Medina-Malpica, Napoleon A.; Medina-Malpica, Otto A.; Droogan, Christopher; Kowey, Peter R.

doi:10.1016/s0735-1097(03)81908-3

Cited by 127 publications

(234 citation statements)

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“…The arrhythmogenic effect of reversing the direction of activation of the LV wall by pacing from epicardium instead of endocardium, has been demonstrated previously under a variety of conditions. 14, 16,18,19 Quinidine (10 µmol/L) completely reversed the effect of PD-118057 on QT interval and ERP. In the presence of quinidine, the increase in TDR persisted but pVT could no longer be induced.…”

Section: Discussionmentioning

confidence: 94%

Cellular basis for arrhythmogenesis in an experimental model of the SQT1 form of the short QT syndrome

Patel

Antzelevitch

2008

Heart Rhythm

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Section: Discussionmentioning

confidence: 94%

Cellular basis for arrhythmogenesis in an experimental model of the SQT1 form of the short QT syndrome

Patel

Antzelevitch

2008

Heart Rhythm

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“…Medina-Ravell et al describe 4 of 29 CRT patients who exhibited a marked increase in JTc and TDR with left or biventricular pacing, accompanied by frequent R-on-T ventricular extrasystoles that were completely inhibited by right ventricular endocardial pacing. 9 One of the four patients developed recurrent nonsustained polymorphic VT and another suffered incessant torsade requiring multiple shocks. In the same patient, torsade could be eliminated with RV pacing and reliably reproduced by turning biventricular pacing on, which was associated with significant QT prolongation (Fig.…”

Section: Clinical Evidence Of Proarrhythmiamentioning

confidence: 95%

“…More compelling data is presented in smaller studies that elucidate the electrophysiologic impact of epicardial pacing and the potentially proarrhythmic effects of cardiac resynchronization therapy. 9,10,25 …”

Section: Mortality Benefit Of Crtmentioning

confidence: 99%

“…This reversal has been shown to create heterogeneous conduction patterns and increase transmural dispersion of repolarization (TDR) in experimental models. 9,25 Such nonuniformity is an established and important determinant of reentrant arrhythmias.…”

Section: Proarrhythmic Mechanismsmentioning

confidence: 99%

“…25 Similar results were reported by Medina-Ravell et al along with an increased number of R-on-T extrasystoles and episodes of torsade de pointes (TdP) with epicardial pacing. 9 The proarrhythmic potential of epicardial pacing is most likely determined by the characteristics of the altered activation sequence and the condition of the underlying substrate. The impact on potentiating triggers (e.g.…”

Section: Proarrhythmic Mechanismsmentioning

confidence: 99%

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Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

Ray¹,

Fendelander²,

Singh³

2007

Clinical Cardiology

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SummaryCardiac resynchronization therapy (CRT) has become an established adjunctive treatment to optimal pharmacologic therapy in patients with advanced chronic heart failure (CHF), diminished left ventricular (LV) function and intraventricular conduction delay. Although CRT has been shown to improve ventricular hemodynamics, quality of life and exercise capacity, there is some evidence that it may rarely potentiate ventricular arrhythmias. As CRT is considered for an expanded population of CHF patients, and left-sided pacing is considered as an option for pacemaker-indicated patients (potentially without defibrillator backup), the effect of these pacing modalities on the incidence of ventricular tachyarrhythmia must be systematically studied and mechanistically understood. Strategies to prospectively predict the proarrhythmic potential of LV epicardial pacing need to be developed, and therapy accordingly individualized. This review attempts to summarize the current information on proarrhythmia in resynchronization therapy.

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Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction

McAlister,

Ezekowitz,

Hooton

et al. 2007

JAMA

545

351

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EART FAILURE IS THE FASTest growing cardiovascular diagnosis in the United States, with a community prevalence of 2.5% in adults, and the direct and indirect costs of heart failure exceed $33 billion per year. 1 Despite many advances in diagnosis and pharmacotherapy for heart failure during the past 2 decades, morbidity and mortality remain high and quality of life is poor for many patients. Thus, there is increasing enthusiasm for the therapeutic potential of atrial-synchronized biventricular pacemakers (cardiac resynchronization therapy [CRT]) in patients with heart failure and left ventricular (LV) systolic dysfunction. CRT is designed to eliminate the delay in activation of the LV free wall found in many patients with LV systolic dysfunction and thereby improves me-See also Patient Page.

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Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization: Does resynchronization therapy pose a risk for patients predisposed to long QT or torsade de pointes?

Cited by 127 publications

References 0 publications

Cellular basis for arrhythmogenesis in an experimental model of the SQT1 form of the short QT syndrome

Cellular basis for arrhythmogenesis in an experimental model of the SQT1 form of the short QT syndrome

Cardiac Resynchronization Therapy and its Potential Proarrhythmic Effect

Cardiac Resynchronization Therapy for Patients With Left Ventricular Systolic Dysfunction

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