scholarly journals Left ventricular pacing induced polymorphic ventricular tachycardia via the adaptive left ventricle pacing algorithm

2020 ◽  
Vol 8 (8) ◽  
pp. 1511-1516
Author(s):  
Fouad Khalil ◽  
Freddy Del‐Carpio Munoz ◽  
Abhishek Deshmukh ◽  
Ammar M. Killu
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricle ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Ventricular Pacing ◽  
Left Ventricular Pacing

scholarly journals Polymorphic Ventricular Tachycardia Induced by Left Ventricular Pacing

Circulation ◽  
2004 ◽  
Vol 109 (23) ◽  
pp. 2924-2925 ◽  
Author(s):  
Máximo Rivero-Ayerza ◽  
Marc Vanderheyden ◽  
Sofie Verstreken ◽  
Marc de Zutter ◽  
Peter Geelen ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Ventricular Pacing ◽  
Left Ventricular Pacing

43Dynamic atrioventricular delay achieves superior electrical synchrony when pacing both ventricles rather than left ventricle alone

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
B Thibault ◽  
A Chow ◽  
J Mangual ◽  
N Badie ◽  
P Waddingham ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Ventricular Pacing ◽  
Right Ventricular Pacing ◽  
Atrioventricular Delay ◽  
Intrinsic Conduction ◽  
Left Ventricular Pacing ◽  
Additional Reference ◽  
The Right

Abstract Funding Acknowledgements Abbott Introduction Automatic adjustment of atrioventricular delay (AVD) with SyncAV has been shown to improve electrical synchronization when pacing one or two sites in the left ventricle together with the right ventricle. However, it is unknown if the same benefit can be gained by using SyncAV while pacing only the left ventricle without right ventricular pacing. Purpose   Evaluate the acute improvement in electrical synchrony provided by SyncAV with and without MultiPoint Pacing (MPP) during biventricular (BiV) and LV only pacing. Methods   Patients with LBBB and QRS duration (QRSd) ≥ 150 ms scheduled for CRT-P/D device implantation with quadripolar LV lead were enrolled in this prospective study. QRSd was measured post-implant from 12-lead surface electrograms by blinded experts during the following pacing configurations: intrinsic conduction, conventional BiV (BiV = RV + LV1), MPP (MPP = RV + LV1 + LV2), LV-only single-site (LVSS = LV1 only), and LV-only MPP (LVMPP = LV1 + LV2). For each pacing mode, SyncAV was enabled (e.g. BiV + SyncAV) with the patient-tailored SyncAV offset that minimized QRSd. As an additional reference, QRSd during BiV was also measured using the nominal static AVD (paced/sensed AVD = 140/110 ms). BiV and LVSS pacing used the latest activating LV cathode, whereas MPP and LVMPP used the two LV cathodes with the widest possible separation (>30mm). All configurations used the minimum programmable RV-LV and LV1-LV2 delays. Results   Thirty-five patients (78% male, 33% ischemic, 26% ejection fraction, 165 ms intrinsic QRSd) completed device implant and QRSd assessment. Relative to intrinsic conduction, BiV with nominal AVD reduced the QRSd by 17.5% (p < 0.001 vs intrinsic). Enabling SyncAV with a patient-optimized offset significantly improved QRSd reduction. BiV + SyncAV reduced QRSd by 25.2% (p < 0.001 vs. BiV). The greatest QRSd reduction of 28.9% was achieved by MPP + SyncAV (p < 0.01 vs. BiV + SyncAV). Single- and multi-site LV-only pacing reduced QRSd significantly less than corresponding biventricular modes. LVSS + SyncAV reduced QRSd by 22.5% (p < 0.05 vs. BiV + SyncAV), and LVMPP + SyncAV reduced QRSd by 24.3% (p < 0.05 vs. MPP + SyncAV). As a percent of PR interval, optimal SyncAV offsets were similar for BiV + SyncAV (median: 13%, mean: 17%) vs. MPP + SyncAV (median: 13%, mean 16%, p = 0.35 vs. BiV + SyncAV), and similar for LVSS + SyncAV (median: 20%, mean: 28%) and LVMPP + SyncAV (median: 23%, mean: 26%, p = 0.35 vs. LVSS + SyncAV), but were significantly higher for LV-only settings vs. corresponding BiV/MPP settings (p < 0.01 for both pairs). Conclusion: Greater improvement in electrical synchrony using SyncAV was observed when right ventricular pacing was included with left ventricular pacing. Additional benefit was gained by the addition of a second left ventricular pacing site with MPP in combination with SyncAV in both biventricular and LV only pacing modes. Abstract Figure.

Impact of an adaptive CRT optimization algorithm on the risk of life-threatening ventricular arrythmias of heart failure patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Briongos Figuero ◽  
A Estevez ◽  
M.L Perez ◽  
J.B Martinez-Ferrer ◽  
L Alvarez ◽  
...  
Keyword(s):  
Ventricular Tachycardia ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Polymorphic Ventricular Tachycardia ◽  
Cardiac Resynchronization ◽  
Ventricular Pacing ◽  
Remote Monitoring System ◽  
Life Threatening ◽  
The Impact

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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