The Impact of the Left Ventricular Pacing Polarity and Localization During Cardiac Resynchronization Therapy on Depolarization and Repolarization Parameters

Overview

Journal Anatol J Cardiol

Publisher Kare Publishing

Specialty Cardiology & Vascular Diseases

Date 2018 Mar 27

PMID 29578202

Citations 1

Authors

Emin Evren Ozcan

Ali Ozturk

Erdem Ozel

Omer Senarslan

Bela Merkely

Laszlo Geller

Affiliations

Soon will be listed here.

Abstract

Objective: Reversal of myocardial activation sequence during cardiac resynchronization therapy (CRT) may increase the transmural dispersion of repolarization (TDR), which may lead to ventricular arrhythmias. Quadripolar left ventricular (LV) leads offer 10 different pacing configurations. However, little is known about the role of pacing polarity on repolarization patterns. Our study aimed to investigate the impact of LV pacing polarity on depolarization and repolarization parameters in the same substrate in the same patient group.

Methods: This study prospectively analyzed 20 patients who were consecutively admitted and underwent CRT-D implantation with quadripolar LV leads. Two bipolar pacing vectors and two unipolar vectors, also called extended bipolar pacing vectors, from the same pacing sites were selected for comparison. Electrocardiogram markers of depolarization and repolarization were measured and compared.

Results: Bipolar LV pacing was associated with a significantly shorter QRS duration (basal, unipolar vs. bipolar, 135.1±17.8 vs. 119.3±14.5, p<0.01; non-basal, unipolar vs. bipolar, 134.4±15.7 vs. 121.9±10.3, p<0.01) and Tp-Te value (Basal, unipolar vs. bipolar, 119.1±36.7 vs. 97.6±27.9, p<0.05; non-basal, unipolar vs. bipolar, 117.9±36.3 vs. 98.6±20.4, p<0.05) than those in unipolar pacing. LV pacing from basal and non-basal segments had no differential effect on the repolarization parameters.

Conclusion: The LV pacing polarity significantly affects QRS duration but not repolarization patterns regardless of the pacing site in the same substrate. From the perspective of basal and non-basal segments, the LV pacing site has no differential effect on the repolarization parameters.

Citing Articles

Capture threshold of bipolar and unipolar pacing of left ventricle via coronary sinus branch: longitudinal study.

Stritecky J, Kremlacek J, Hanus J, Haman L, Stritecka H, Simka J Front Cardiovasc Med. 2023; 10:1096538.

PMID: 37288262 PMC: 10242161. DOI: 10.3389/fcvm.2023.1096538.

References

Fish J, Di Diego J, Nesterenko V, Antzelevitch C . Epicardial activation of left ventricular wall prolongs QT interval and transmural dispersion of repolarization: implications for biventricular pacing. Circulation. 2004; 109(17):2136-42. DOI: 10.1161/01.CIR.0000127423.75608.A4. View

Mounsey J, Knisley S . Anodal capture, cathodal capture, and left ventricular cardiac excitation. J Cardiovasc Electrophysiol. 2009; 20(6):650-2. DOI: 10.1111/j.1540-8167.2008.01418.x. View

Kutyifa V, Zareba W, McNitt S, Singh J, Hall W, Polonsky S . Left ventricular lead location and the risk of ventricular arrhythmias in the MADIT-CRT trial. Eur Heart J. 2012; 34(3):184-90. DOI: 10.1093/eurheartj/ehs334. View

Valzania C, Eriksson M, Biffi M, Boriani G, Gadler F . Acute changes in electromechanical parameters during different pacing configurations using a quadripolar left ventricular lead. J Interv Card Electrophysiol. 2013; 38(1):61-9. DOI: 10.1007/s10840-013-9812-8. View

Ouellet G, Huang D, Moss A, Hall W, Barsheshet A, McNitt S . Effect of cardiac resynchronization therapy on the risk of first and recurrent ventricular tachyarrhythmic events in MADIT-CRT. J Am Coll Cardiol. 2012; 60(18):1809-16. DOI: 10.1016/j.jacc.2012.05.057. View

Cleland J, Daubert J, Erdmann E, Freemantle N, Gras D, Kappenberger L . The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352(15):1539-49. DOI: 10.1056/NEJMoa050496. View

Abraham W, Fisher W, Smith A, DeLurgio D, Leon A, Loh E . Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346(24):1845-53. DOI: 10.1056/NEJMoa013168. View

Wecke L, van Deursen C, Bergfeldt L, Prinzen F . Repolarization changes in patients with heart failure receiving cardiac resynchronization therapy-signs of cardiac memory. J Electrocardiol. 2011; 44(5):590-8. DOI: 10.1016/j.jelectrocard.2011.06.006. View

Calo L, Martino A, De Ruvo E, Minati M, Fratini S, Rebecchi M . Acute echocardiographic optimization of multiple stimulation configurations of cardiac resynchronization therapy through quadripolar left ventricular pacing: a tailored approach. Am Heart J. 2014; 167(4):546-54. DOI: 10.1016/j.ahj.2013.12.028. View

10.

Jame S, Kutyifa V, Aktas M, McNitt S, Polonsky B, Al-Ahmad A . Bipolar left ventricular pacing is associated with significant reduction in heart failure or death in CRT-D patients with LBBB. Heart Rhythm. 2016; 13(7):1468-74. DOI: 10.1016/j.hrthm.2016.03.009. View

11.

St John Sutton M, Plappert T, Abraham W, Smith A, DeLurgio D, Leon A . Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation. 2003; 107(15):1985-90. DOI: 10.1161/01.CIR.0000065226.24159.E9. View

12.

Wikswo Jr J, Wisialowski T, Altemeier W, Balser J, Kopelman H, Roden D . Virtual cathode effects during stimulation of cardiac muscle. Two-dimensional in vivo experiments. Circ Res. 1991; 68(2):513-30. DOI: 10.1161/01.res.68.2.513. View

13.

Fish J, Brugada J, Antzelevitch C . Potential proarrhythmic effects of biventricular pacing. J Am Coll Cardiol. 2005; 46(12):2340-7. PMC: 1474835. DOI: 10.1016/j.jacc.2005.08.035. View

14.

Durrer D, VAN DER TWELL L . Spread of activation in the left ventricular wall of the dog. I. Am Heart J. 1953; 46(5):683-91. DOI: 10.1016/0002-8703(53)90221-x. View

15.

Ozcan E, Szilagyi S, Sallo Z, Molnar L, Zima E, Szeplaki G . Comparison of the Effects of Epicardial and Endocardial Cardiac Resynchronization Therapy on Transmural Dispersion of Repolarization. Pacing Clin Electrophysiol. 2015; 38(9):1099-105. DOI: 10.1111/pace.12678. View

16.

Bristow M, Saxon L, Boehmer J, Krueger S, Kass D, De Marco T . Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004; 350(21):2140-50. DOI: 10.1056/NEJMoa032423. View

17.

Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C . Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001; 344(12):873-80. DOI: 10.1056/NEJM200103223441202. View

18.

Yang H, Caracciolo G, Sengupta P, Goel R, Chandrasekaran K, Srivathsan K . Pacing polarity and left ventricular mechanical activation sequence in cardiac resynchronization therapy. J Interv Card Electrophysiol. 2012; 35(1):101-7. DOI: 10.1007/s10840-012-9686-1. View

19.

Young J, Abraham W, Smith A, Leon A, Lieberman R, Wilkoff B . Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial. JAMA. 2003; 289(20):2685-94. DOI: 10.1001/jama.289.20.2685. View

20.

Barbhaiya C, Po J, Hanon S, Schweitzer P . Tpeak - Tend and Tpeak - Tend /QT ratio as markers of ventricular arrhythmia risk in cardiac resynchronization therapy patients. Pacing Clin Electrophysiol. 2012; 36(1):103-8. DOI: 10.1111/pace.12031. View