Feasibility of cathodic‐anodal left ventricular stimulation for alternative multisite pacing

Dell’Era, Gabriele; Vecchi, Federica De; Prenna, Eleonora; Devecchi, Chiara; Degiovanni, Anna; Malacrida, Maurizio; Magnani, Andrea; Occhetta, Eraldo; Marino, Paolo

doi:10.1111/pace.13344

Cited by 9 publications

(14 citation statements)

References 17 publications

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“…The prevalence of AS reported in this work is similar to the prevalence previously described in the adult literature 2,3,5,6,8 . Our series of 24 bipolar leads in 23 children is the first report in the literature of the prevalence of AS in a pediatric population.…”

Section: Discussionsupporting

confidence: 90%

“…The recognition of AS may have further relevance with the increasing use of multisite pacing in pediatrics. In the adult cardiac resynchronization therapy literature, AS has been implicated as a culprit of clinical non‐response 2,3 and a possible cause of improved resynchronization with so‐called “triple site pacing” 4,7,8 . Harnessing the principles of “triple site pacing” and the prevalent nature of AS may allow clinicians to utilize existing bipolar epicardial pacemakers as multisite pacing systems in patients with poor hemodynamics and ventricular dyssynchrony.…”

Section: Discussionmentioning

confidence: 99%

“…In bipolar pacing systems, capture of the myocardium typically occurs at the negatively charged electrode or cathode. However, the phenomenon of anodal stimulation (AS) with simultaneous capture at the positively charged electrode or anode has been described in adult populations 2–8 . This has been most frequently described in adults receiving cardiac resynchronization therapy.…”

Section: Introductionmentioning

confidence: 99%

“…This has been most frequently described in adults receiving cardiac resynchronization therapy. The incidence of AS in adults with biventricular pacing systems ranges from 37% to 100% 2,3,5,6,8 . AS is more common at higher pacing outputs.…”

Section: Introductionmentioning

confidence: 99%

“…Furthermore, this potential risk was theorized primarily in older asynchronous pacemaker systems. More recently, there has been increasing interest in AS in the adult cardiac resynchronization therapy literature as both a culprit of clinical non‐response 2,3 and a possible cause of improved resynchronization with so‐called “triple site pacing” 4,7,8 …”

Section: Introductionmentioning

confidence: 99%

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Anodal stimulation in pediatric patients with permanent epicardial ventricular pacemakers

Boscamp

Liberman

Silver

2021

Pacing Clinical Electrophis

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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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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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