The Relationship of Bipolar Left Ventricular Pacing Stimulus Intensity to Cardiac Depolarization and Repolarization in Humans with Cardiac Resynchronization Devices

Theis, C.; Bavikati, Venkata V.; Langberg, Jonathan J.; Lloyd, Michael S.

doi:10.1111/j.1540-8167.2008.01378.x

Cited by 17 publications

(22 citation statements)

References 18 publications

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“…Increased stimulus intensity led to a prolongation of QTc from 539 ± 45 (0.5 V > LV threshold) to 559 ± 46 mseconds (5 V < LV threshold). These findings had important implications on the relationship of programmed LV pacing output to pacing‐induced proarrhythmia . Furthermore, high epicardial pacing output might induce the bigger delta VT‐CL and delta QRS duration during VT.…”

Section: Discussionmentioning

confidence: 99%

Association left ventricular lead and ventricular arrhythmias after upgrade to cardiac resynchronization therapy in patients with implantable cardioverter defibrillators

Kawamura

Arai

Yoshikawa

et al. 2019

Clinical Cardiology

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Background There are some controversial reports related to the pro‐arrhythmic or anti‐arrhythmic potential of cardiac resynchronization therapy (CRT) and little is known about the relationship between ventricular arrhythmia (VA) and left ventricular (LV)‐lead threshold. Hypothesis Upgrade CRT is anti‐arrhythmic effect of VA with implantable cardioverter‐defibrillator (ICD) patients and has a relationship with the incident of VA and LV‐lead threshold. Methods Among 384 patients with the implantation of CRT‐defibrillator (CRT‐D), 102 patients underwent an upgrade from ICD to CRT‐D. We divided patients into three groups; anti‐arrhythmic effect after upgrade (n = 22), pro‐arrhythmic effect (n = 14), and unchanging‐VA events (n = 66). The VA event was determined by device reports. We described the electrocardiography parameters, LV‐lead characteristics, and clinical outcomes. Results Before upgrade, the numbers of VA were 305 episodes and the numbers of ICD therapy were 157 episodes. While after upgrade, the numbers of VA were 193 episodes and the number of ICD therapy were 74 episodes. Ventricular tachycardia cycle length (VT‐CL) after upgrade was significantly slower as compared to those with before upgrade. Pro‐arrhythmic group was significantly higher with delta LV‐lead threshold (after 1 month—baseline) as compared to those with anti‐arrhythmic group (0.74 vs −0.21 V). Furthermore, pro‐arrhythmic group was significantly bigger with delta VT‐CL (after 3 months—before 3 months) as compared to those with anti‐arrhythmic group ( P = .03). Conclusions We described upgrade‐CRT was associated with reduction of VA, ICD therapies and VT‐CL. While 14 patients had a pro‐arrhythmic effect and LV lead threshold might be associated with VA‐incidents.

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Section: Discussionmentioning

confidence: 99%

Association left ventricular lead and ventricular arrhythmias after upgrade to cardiac resynchronization therapy in patients with implantable cardioverter defibrillators

Kawamura

Arai

Yoshikawa

et al. 2019

Clinical Cardiology

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“…Secondly, although previous study suggested that programmed V-V delay had impact on QT, JT and Tp-e (16), it was different or not provided in our included studies. Thirdly, the intensity of pacing during our included studies was not available, although LV pacing intensity was proved to have a positive correlation with QT interval (38). Fourthly, although 14 studies were included in this meta-analysis, only 1 study provided all the four endpoints, more than half of the studies provided only 1 endpoint.…”

Section: Study Limitationsmentioning

confidence: 99%

Effect of cardiac resynchronization therapy on ventricular repolarization: A meta-analysis

Xu¹,

Gao²

2015

Anatol J Cardiol

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Objective:Cardiac resynchronization therapy (CRT) was thought to have a proarrhythmic effect on ventricular repolarization. But the results of previous studies were inconsistent. The aim of this study was to determine the effect of CRT on ventricular repolarization.Methods:A meta-analysis of studies focused on the effect of CRT on ventricular repolarization in patients undergoing CRT was conducted. Endpoints including QT interval (QT), JT interval (JT), QT dispersion(QTD) and interval between the peak to end of T wave (Tp-e).Results:A total of 14 studies were included in our meta-analysis. After pooling the data, no significant difference was observed in QT, JT and Tp-e between biventricular (BV) pacing and intrinsic ventricular rhythm. BV paced QTD was lower than intrinsic QTD, but the significance was ambiguous [mean difference (MD): -17.33, 95% CI -34.44 to -0.22, p=0.05]. Left ventricular (LV) paced Tp-e was significantly longer than intrinsic Tp-e (MD: 21.44, 95% CI 2.37 to 40.51, p=0.03). No significant difference was observed in QT, JT and QTD between LV pacing and intrinsic ventricular rhythm.Conclusion:In patients undergoing CRT, BV pacing has no deteriorating effect on ventricular repolarization, but LV pacing has a prolonging effect on Tp-e.

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“…In this case, the wave front originates from the "virtual cathodes." Understanding anodal stimulation is important, because it may be advantageous to stimulate with an anode in certain situations [21][22][23][24].…”

Section: Unipolar Stimulationmentioning

confidence: 99%

Numerical Simulations of Cardiac Tissue Excitation and Pacing Using the Bidomain Model

Roth¹

2011

TOPETJ

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Abstract:The last two decades have produced significant advances in our theoretical understanding of cardiac pacing. The bidomain model, a mathematical representation of the anisotropic electrical properties of cardiac tissue, has provided insight into many long-standing mysteries of pacing, such as the mechanisms of make and break excitation, the shape of the strength-interval curve, and the induction of reentry by burst pacing. This paper reviews the application of the bidomain model to these and other topics, and summarizes our theoretical understanding of how electrical excitation of the heart works.

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The Relationship of Bipolar Left Ventricular Pacing Stimulus Intensity to Cardiac Depolarization and Repolarization in Humans with Cardiac Resynchronization Devices

Cited by 17 publications

References 18 publications

Association left ventricular lead and ventricular arrhythmias after upgrade to cardiac resynchronization therapy in patients with implantable cardioverter defibrillators

Association left ventricular lead and ventricular arrhythmias after upgrade to cardiac resynchronization therapy in patients with implantable cardioverter defibrillators

Effect of cardiac resynchronization therapy on ventricular repolarization: A meta-analysis

Numerical Simulations of Cardiac Tissue Excitation and Pacing Using the Bidomain Model

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