B-AB19-03 ADAPTIVE LEFT VENTRICULAR PACING-INDUCED QT PROLONGATION AND POLYMORPHIC VENTRICULAR TACHYCARDIA IN A PATIENT WITH A NEWLY IMPLANTED CARDIAC RESYNCHRONIZATION DEVICE

Abstract Introduction Adaptive cardiac resynchronization therapy (aCRT) algorithm provides ambulatory CRT optimization and synchronized left-ventricular pacing instead of conventional biventricular pacing. Purpose To analyze the impact of aCRT on the risk of life-threatening ventricular arrythmia (VA) in patients with concomitant defibrillator therapy. Methods Symptomatic HF patients, in sinus rhythm, with LVEF ≤35% and QRS complex ≥130 ms undergoing first CRT-defibrillator (CRT-D) implant were collected from the multicentre, prospective and nationwide UMBRELLA study (2012–2017). All device information was automatically stored and collected through the remote monitoring system. An experts committee analysed in a blinded manner all electrograms. The endpoint was first appropriate therapy (AT) delivered within ventricular fibrillation zone at 12-months follow-up. Results 206 patients were collected (66.1±8.7 years; 73.3% male). Fifty nine patients composed the aCRT group and 147 composed the non-aCRT group. At implant, LBBB was present in 93% of patients, functional class III or IV in 69.9%, non-ischemic HF in 63.1% of patients and mean LVEF was 26.5±5.6%. Optimal medical treatment was achieved in a majority (B-blockers in 92%; RAASi in 89% and MRA in 72.2%). The percentage of ventricular pacing through 12 months was 96.1±9.4% in non-aCRT patients and 97.5±2.7% in aCRT patients (p=0.261). At 1-year of follow-up, 16 patients were delivered an AT (event rate: 7.8%). Most of these episodes (n=14) were due to sustained monomorphic ventricular tachycardia while the rest were caused by sustained polymorphic ventricular tachycardia/VF. A lower incidence of AT was observed in aCRT patients (3.4%) compared to non-aCRT patients (9.5%) but with no statistical differences (OR=0.33, CI 0.07–1.51, p=0.155). Conclusions In patients undergoing CRT provided by aCRT algorithm the risk of malign VA after 1-year of follow-up was low. Randomized studies are needed to clarify the impact of this dynamic algorithm on the arrhythmic risk of HF patients. Funding Acknowledgement Type of funding source: None

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Faculty Opinions recommendation of Invasive optimization of cardiac resynchronization therapy: role of sequential biventricular and left ventricular pacing.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1027859.335824 ◽

2005 ◽

Author(s):

Michael Frenneaux

Keyword(s):

Cardiac Resynchronization Therapy ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Resynchronization Therapy ◽

Left Ventricular Pacing

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Transvenous dual site left ventricular pacing plus biventricular pacing for the management of refractory ventricular tachycardia

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-006-9047-z ◽

2007 ◽

Vol 17 (1) ◽

pp. 73-75 ◽

Cited By ~ 6

Author(s):

Helbert Acosta ◽

Vijayasimha R. Pothula ◽

John Arter ◽

Cindy Antonio ◽

Sumati Ramadas ◽

...

Keyword(s):

Ventricular Tachycardia ◽

Biventricular Pacing ◽

Left Ventricular ◽

Ventricular Pacing ◽

Left Ventricular Pacing ◽

Dual Site

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Video-Assisted Implantation of a Left Ventricular Lead and Intrathoracic Tunneling to a Right-Sided CRT-D Device

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182372464 ◽

2011 ◽

Vol 6 (5) ◽

pp. 341-343

Author(s):

Thijs Stoker ◽

Theo J. Klinkenberg ◽

Alexander H. Maass ◽

Massimo A. Mariani

Keyword(s):

Left Ventricular ◽

Pleural Space ◽

Left Ventricular Lead ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Video Assisted ◽

Ventricular Lead ◽

Pacing Lead ◽

Left Ventricular Pacing ◽

The Right

We describe two cases in which a biventricular implantable cardioverter defibrillator for cardiac resynchronization therapy had to be placed on the right side due to unsuitability of the left subclavian vein. Endocardial implantation of a left ventricular lead through the coronary sinus was previously attempted but was unsuccessful. Implantation of the epicardial left ventricular pacing lead was performed through video-assisted thoracic surgery on the left side. The connector end of the left ventricular pacing lead was tunnelized through the anterior mediastinum into the right pleural space. The right-sided pocket was then opened. A tunnel was created from the pocket to the thoracic wall, and the pleural space was entered over the second rib. The lead was retrieved from the right pleural space and connected with the Cardiac resynchronization therapy-device (CRT-D). Both procedures and postoperative periods were uneventful. Intrathoracic left-to-right tunneling of an epicardial left ventricular lead by video-assisted thoracic surgery is feasible and safe. It provides an alternative to subcutaneous tunneling.

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Multisite, multipoint pacing

In a good rythm ◽

10.5604/01.3001.0010.3966 ◽

2017 ◽

Vol 2 (43) ◽

pp. 9-13

Author(s):

Przemysław Mitkowski

Keyword(s):

Nyha Class ◽

Standard Of Care ◽

Left Ventricular ◽

Cardiac Resynchronization ◽

Ventricular Pacing ◽

Reduced Ejection Fraction ◽

Clinical Benefits ◽

Qrs Duration ◽

Left Ventricular Pacing ◽

Rv Pacing

Cardiac resynchronization therapy in patients with heart failure, reduced ejection fraction and prolonged QRS duration has become standard of care. Unfortunately, despite improvements in delivery of this treatment still approximately 30% of patients are non-responders. Among causes of this phenomenon one can find an inability to deliver hemodynamically effective left ventricular pacing. There were proposed several solutions to solve the problem, including: multisite RV pacing, multisite LV pacing, multipoint LV pacing. Multisite RV pacing (two RV leads positioned in RV: apex and RVOT), although causes some hemodynamic improvement in LVEF or distance in 6MWT and reduction of LVESD or number of hospitalizations in comparison to no paced patients, but its efficacy is significantly worse than normal CRT. So it should not be considered as an alternative to CRT even to surgically placed LV lead. Multisite LV pacing (two leads iv cardiac veins) gives significant benefits over standard CRT, especially in patients with poor heart vein system, which preclude optimal LV lead placement. Clinical benefits of this mode of therapy were observed in non-responders to classical CRT, and were proved in: higher responder rates, improved EF, VO2, distance in 6MWT, reduction of NYHA class, LVESV, LVEDD and increase of dP/dt. Multipoint LV pacing (different pacing point located on the same LV lead) is encouraging way of CRT delivery and does not require any additional lead. Benefits of MP pacing over classical CRT were proved in numerous trails in acute tests by improvement in dP/dt, increase in maximal strain rate, shortening of total activation time, reduction in QRS duration and after mid- and long term follow-up in reduction of LVESV, increase in EF, reduction of asynchrony and higher percentage of responders. Multipoint left ventricular pacing should be a standard of CRT delivery in first implantations.

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