Right ventricular lead proarrhythmia: A novel intervention for an under-recognized phenomenon

Right ventricular lead induced ventricular arrhythmia—A rare complication of cardiac resynchronization therapy

“…Similar case of monomorphic VT resulting from RV pacing in a patient with CRT device implanted has been described previously by Hayase et al and arrhythmias resolved by programming LV preceding RV pacing (Hayase et al, ). Other authors successfully treated the patient with CRT device and RV lead pacing triggered ventricular arrhythmia with the use of catheter ablation (Pedretti et al, ).…”

“…This is consistent with results of ECHO‐CRT trial where CRT was first shown to increase mortality in narrow‐QRS heart failure population. Up to date, only single cases of late RV pacing‐induced arrhythmias have been reported and different individualized treatment strategies were applied (Hayase, Khakpour, Shivkumar, & Bradfield, ; Pedretti, Vargiu, Paolucci, & Lunati, ).…”

Ventricular tachycardia exacerbated by left bundle branch area pacing

“…There have been multiple reports on the proarrhythmic effects of cardiac resynchronization therapy, single- and dual-chamber pacemakers/ICDs. 3 , 4 , 5 , 6 In 2003, Himmrich and colleagues 3 described episodes of VT with onset after a single visible and effective pacemaker stimulus as “pacemaker-induced ventricular tachycardia/fibrillation (PIT)” in ICD patients with VVI backup pacing programming. The authors demonstrated in their randomized crossover study that sustained ventricular arrhythmias no longer occurred after the pacemaker backup feature was deactivated, implying that stimulated impulses were responsible for inducing the VT / ventricular fibrillation and that the arrhythmia did not occur independent of ventricular stimulation.…”

“…Slow conduction may coexist with unidirectional conduction block and may result in emergence of reentry. 4 Additionally, pacing within or very close to the region of slow conduction responsible for the clinical VT circuit in patients with ventricular substrate/scar may have a proarrhythmic effect. 4 This mechanism was previously described as “pace-map induction” of VT. 7 …”

Mechanically induced electrical storm as a complication of cardiac resynchronization therapy: A case report

“…Cardiac resynchronization therapy (CRT) has been shown to improve both the functional status and mortality of chronic heart failure patients with left bundle branch block in large, randomized controlled trials [ 1 , 2 ]. However, evidence in recent case reports and cohort studies suggest left ventricular (LV) epicardial or right ventricular (RV) pacing in a CRT device may be proarrhythmic [ [3] , [4] , [5] , [6] , [7] ]. The proposed mechanisms include pacing into regions of arrhythmic substrate leading to scar related reentry, and LV epicardial pacing causing reversal of ventricular activation and prolongation of transmural dispersion of repolarization (TDR) [ 8 ].…”