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Biventricular Pacing Has an Advantage over Left Ventricular Epicardial Pacing Alone to Minimize Proarrhythmic Perturbation of Repolarization
Author(s) -
HARADA MASAHIDE,
OSAKA TOSHIYUKI,
YOKOYAMA ERIKO,
TAKEMOTO YOSHIO,
ITO ATSUSHI,
KODAMA ITSUO
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2005.00310.x
Subject(s) - medicine , cardiac resynchronization therapy , cardiology , repolarization , qrs complex , heart failure , sinus rhythm , ventricular pacing , qt interval , ejection fraction , atrial fibrillation , electrophysiology
Cardiac resynchronization therapy (CRT) by simultaneous biventricular pacing is now widely accepted as a new therapeutic option for patients with severe congestive heart failure (CHF). Recent studies have shown comparable hemodynamic benefits of left ventricular (LV) pacing alone. The clinical usefulness of CRT, however, might be compromised by potential exaggeration of arrhythmogenic substrates through a modification of ventricular repolarization. Methods and Results: We compared ECG parameters during sinus rhythm (SR), atrioventricular synchronous pacing at the right ventricular apex (RV end P), at LV epicardium (LV epi P), and at both sites (BiVP) in acute homodynamic studies of 14 CHF patients scheduled for CRT (QRS duration = 144 ± 23 msec, LVEF = 27 ± 10%). The maximum rate of increase in LV pressure (LVdp/dt max ) was decreased significantly during RV end P, whereas it was increased similarly during LV epi P and BiVP compared with SR. QTc was increased during RV end P (by 10.2%) and LV epi P (by 26.1%). QTc dispersion (QTc max ‐QTc min in the six precordial leads) was also increased during LV epi P (by 66.5%). These parameters were unaffected during BiVP. JTc was unchanged, and the interval from the peak to the end of the T wave (Tc peak‐end ) was increased slightly (by 19.3%) during RV end P. Both JTc and Tc peak‐end were increased dramatically during LV epi P (by 18.2% and 55.4%, respectively), but increased only modestly during BiVP (by 6.6% and 15.8%, respectively). Conclusions: LV epi P causes much greater increase in spatial dispersion of ventricular repolarization than BiVP in CHF patients. BiVP may have a substantial advantage over LV epi P to minimize the proarrhythmic perturbation of ventricular repolarization in association with CRT.