Proarrhythmic effect of pacemaker stimulation in patients with implanted cardioverter-defibrillators

Bradycardia Pacing-Induced Short-Long-Short Sequences at the Onset of Ventricular Tachyarrhythmias

“…A causal relationship between isolated VPs and VT/VF was established in a small study where 26% of single-chamber ICD patients had pacing facilitated VT/VF (8). The present study extends this concept amongst a much larger and more diverse cohort and demonstrates that critically timed delivery of isolated VPs in any pacing mode might actively facilitate S-L-S VT/VF.…”

“…This approach likely failed owing to: 1) overemphasis on pause duration, and 2) lack of awareness of the proarrhythmic effect of critically timed VPs (VPD mimicry). In 1 small study of highly selected patients, suppression of pauses by increasing the pacing rate in VVI/R did not prevent pacing-facilitated VT/VF in any patient, whereas deactivation of pacing abolished the phenomenon despite increased duration of pauses (8). Our data supports this observation, because in all modes the minimum pause duration during pacing-facilitated S-L-S VT/VF was 500 ms and relatively small numbers of episodes occurred after pauses Ͼ1,000 ms.…”

Potential proarrhythmic effect of biventricular pacing: Fact or myth?

“…2,[12][13][14][15][16][17][18] However, evidence reported in the literature suggests that pacing itself potentially provokes arrhythmia. Proarrhythmic effects of RV apical pacing have been described, 19 and there are few case reports of occurrence of polymorphic VT after biventricular pacing. 21,22 To our knowledge, this is the first case series describing precipitation of ventricular tachyarrhythmias, primarily monomorphic VT, after initiation of biventricular pacing.…”

“…2,[12][13][14][15][16][17][18] Large-scale trials of CRT have not reported proarrhythmia [2][3][4][5][6][7][8][9][10][11] ; however, single-site right ventricular (RV) pacing has been shown to be proarrhythmic in patients with an implantable cardioverter-defibrillator (ICD). 19 There have been sporadic case reports of precipitation of VT/ ventricular fibrillation (VF) with CRT. 18,20 -23 We report a series of patients in whom implantation of a CRT device resulted in VT/VF storm with predominance of monomorphic VT.…”

Effect of cardiac resynchronization therapy on the incidence of electrical storm

“…Evidence reported in the literature suggests that pacing itself might provoke arrhythmias, and proarrhythmic effects of RV apical pacing have been described [29]. Furthermore, there are now several case reports of occurrence of ventricular tachycardia, ventricular fibrillation, and even electrical storm after biventricular pacing [11][12][13].…”