Left Ventricular Lead Placement for Pacing and Sensing in a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy Undergoing ICD Implantation

Taleski, Jane; Manola, Šime; Radeljić, Vjekoslav; Bulj, Nikola; Brkljačić, Diana Delić; Pavlović, Nikola

doi:10.20471/acc.2019.58.02.26

Cited by 2 publications

(2 citation statements)

References 6 publications

(8 reference statements)

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“… 9 In ARVC, progressive myocardium loss causes significant deterioration in R-wave sensing and defects in VT/VF detection. 5 , 10 Taleski et al 6 have implanted a trans-CS LV lead to enhance the ICD sensing in an ARVC patient, but it is challenging due to right heart enlargement and unstable contact with the epicardial myocardium to maintain sufficient R-wave sensing. In contrast, LBBAP was confirmed to produce more stable and excellent performance.…”

Section: Discussionmentioning

confidence: 99%

“… 5 A case report has demonstrated the feasibility of a trans-coronary sinus (trans-CS) left ventricular (LV) lead in improving ICD’s R-wave sensing. 6 In recent years, left bundle branch area pacing (LBBAP) was popularized, including left bundle branch pacing and left ventricular septal pacing (LVSP). 7 It is achieved by a trans-septal lead screwed from the right to the left side of the ventricular septum, capturing the LV septal (LVS) myocardium or left bundle branch fibres.…”

Section: Introductionmentioning

confidence: 99%

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Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Chen

Dai

et al. 2022

European Heart Journal - Case Reports

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Background Implantable cardioverter-defibrillator (ICD) implantation is a key therapeutic option in arrhythmogenic right ventricular cardiomyopathy (ARVC) to prevent sudden cardiac death due to ventricular tachycardia (VT) and fibrillation (VF). However, sub-optimized R-wave sensing due to myocardium loss interferes with VT/VF identification and appropriate therapy. We tried to implant a 3830 lead to the left ventricular septum (LVS) to facilitate ICD sensing in an ARVC patient. Case summary A 68-year-old woman diagnosed with ARVC was scheduled to undergo ICD implantation. Initially, no sites with suitable R-wave amplitudes were found in the right ventricle (RV) to deploy the defibrillation lead (<3.0 mV). It was likely due to severe RV involvement, but the LVS myocardium was more preserved based on cardiac magnetic resonance imaging. Therefore, we implanted a 3830 lead into the deep area of the septum to facilitate R-wave sensing. During the procedure from the right to left septum, the R-wave amplitude significantly increased (2.6 mV to 4.3∼7.1 mV). LVS pacing was finally achieved with favorable R-wave sensing (9.9 mV 24 hours post-operation). The 3830 lead was plugged into the IS-1 port, while the defibrillation lead was plugged into the DF-1 port. After a four-month follow-up, the R-wave amplitude of the 3830 lead was 11.1 mV. Discussion When the R-wave sensing is not acceptable for ICD implantation in ARVC patients, it is critical to assess myocardial conditions comprehensively. If the septal myocardium is preserved, implanting a 3830 lead to the deep or left ventricular septum is feasible to improve R-wave sensing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Chen

Dai

et al. 2022

European Heart Journal - Case Reports

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Radial and Circumferential CMR-Based RV Strain Predicts Low R Wave Amplitude after ICD Implantation in Patients with Arrhythmogenic Cardiomyopathy

Chen

Song

Chen

et al. 2023

JCM

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Inadequate R wave amplitude (RWA) after implantable cardiac defibrillator (ICD) implantation in patients with arrhythmogenic cardiomyopathy (ACM) was suspected to relate to right ventricle impairment. However, little data-based evidence was provided to quantify the association. We retrospectively enrolled ACM patients receiving CMR examinations before transvenous ICD implantation from Fuwai Hospital. The RWA was obtained within 24 h and at 2–6-month follow-up after the operation. Structural, functional, as well as tissue characterization of the left ventricle (LV) and right ventricle (RV), were analyzed in relation to RWA. Among the 87 ACM patients (median RWA:8.0 mV), 19 (21.8%) patients were found with low initial RWA (<5 mV) despite attempts in multiple positions. RV end diastolic diameter (RVEDD), (r = −0.44), RV ejection fraction (RVEF, r = 0.43), RV end diastolic volume index (RVEDVi, r = −0.49), RV end systolic volume index (RVESVi, r = −0.53), RV global circumferential (RVGCS, r = −0.64), and radial strain (RVGRS, r = 0.61, all p < 0.001) rather than LV metrics correlated strongly with initial RWA. RVGCS, RVESVi, and RVGRS were decent predictors of low RWA (areas under the curve AUC: 0.814, 0.769, 0.757, respectively) early after implantation and during 2–6-month follow-up. To summarize, low RWA of ICD lead in ACM patients was associated with RV abnormalities. The RVGCS, RVGRS, and RVESVi can be valuable predictors for identifying low RWA prior to ICD implantation.

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Left Ventricular Lead Placement for Pacing and Sensing in a Patient with Arrhythmogenic Right Ventricular Cardiomyopathy Undergoing ICD Implantation

Cited by 2 publications

References 6 publications

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Radial and Circumferential CMR-Based RV Strain Predicts Low R Wave Amplitude after ICD Implantation in Patients with Arrhythmogenic Cardiomyopathy

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