Long Pacing Pulses Reduce Phrenic Nerve Stimulation in Left Ventricular Pacing

Hjortshøj, Søren Pihlkjær; Heath, Finn; Haugland, Morten Kristian; Eschen, Ole; Thøgersen, D.M.S.C. Anna Margrethe; Riahi, Sam; Toft, D.M.S.C. Egon; Struijk, Johannes

doi:10.1111/jce.12345

Cited by 13 publications

(11 citation statements)

References 18 publications

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“…The resulting strength duration curves demonstrated that the chronaxie of LV myocardium was higher than that of the phrenic nerve . In 3 patients, an unfavorable very small or zero margin was rendered higher to at least a factor of 2 . The largest change between the 2 thresholds was observed up to a pulse width of 1.5 milliseconds …”

Section: Editorial Commentmentioning

confidence: 90%

“…During the implant procedure, LV and phrenic nerve capture thresholds were determined at varying pulse widths, from 0.3 to 2.9 milliseconds. In 9 of 11 patients, the LV threshold was reduced at a greater rate than the phrenic nerve threshold with increasing pulse width . The resulting strength duration curves demonstrated that the chronaxie of LV myocardium was higher than that of the phrenic nerve .…”

Section: Editorial Commentmentioning

confidence: 95%

“…In this issue of the Journal of Cardiac Electrophysiology , Hjortshoj and his colleagues, examine the relationship of capture of LV myocardium and the phrenic nerve, to changes in pacing voltage and pulse width . Eleven patients undergoing CRT implants with phrenic nerve stimulation observed were included in the study .…”

Section: Editorial Commentmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac Resynchronization Therapy: Extending Current Responses to Phrenic Nerve Stimulation

Weinstock

Estes

2014

Cardiovasc electrophysiol

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Section: Editorial Commentmentioning

confidence: 90%

Section: Editorial Commentmentioning

confidence: 95%

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Cardiac Resynchronization Therapy: Extending Current Responses to Phrenic Nerve Stimulation

Weinstock

Estes

2014

Cardiovasc electrophysiol

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“…In clinical studies, a threshold difference less than 3 V has been associated with clinically significant phrenic stimulation (19). Other strategies that have been reported in the literature include using leads with multiple electrodes allowing for reprogramming between electrodes (20), using closely spaced bipoles (21), and having longer pulse duration (22), although we did not attempt to replicate these findings for epicardial pacing or investigate whether they have incremental effect.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead

Syed

DeSimone

Ebrille

et al. 2015

JACC: Clinical Electrophysiology

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Introduction Epicardial cardiac resynchronization therapy (CRT) permits unrestricted electrode positioning. However, this requires surgical placement of device leads and the risk of unwanted phrenic nerve stimulation. We hypothesized that shielded electrodes can capture myocardium without extracardiac stimulation. Methods In 6 dog and 5 swine experiments, we used a percutaneous approach to access the epicardial surface of the heart, and deploy novel leads housing multiple electrodes with selective insulation. Bipolar pacing thresholds at prespecified sites were tested compare electrode threshold data both facing towards and away from the epicardial surface. Results In 151 paired electrode recordings (70 in 6 dogs; 81 in 5 swine), thresholds facing myocardium were lower than facing away (median [IQR] mA: dogs 0.9 [0.4–1.6] vs 4.6 [2.1 to >10], p<0.0001; swine 0.5 [0.2–1] vs 2.5 [0.5–6.8], p<0.0001). Myocardial capture was feasible without extracardiac stimulation at all tested sites, with mean ± SE threshold margin 3.6±0.7 mA at sites of high output extracardiac stimulation (p=0.004). Conclusion Selective electrode insulation confers directional pacing to a multielectrode epicardial pacing lead. This device has the potential for a novel percutaneous epicardial resynchronization therapy that permits placement at an optimal pacing site, irrespective of the anatomy of the coronary veins or phrenic nerves.

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“…Another area where knowledge of strength-duration curves for the HB might play a role is the achievement of selective vs nonselective HB capture. A few studies reported that differences in chronaxie values enable selective pacing of different tissues from the same electrode by using a different combination of pulse widths and voltage output [12][13][14][15] ; whether this is also the case with HB/RV myocardium capture is not known.…”

Section: Introductionmentioning

confidence: 99%

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

et al. 2019

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BACKGROUND Strength-duration curves for permanent His bundle (HB) pacing are potentially important for pacemaker programming.OBJECTIVES We aimed to calculate strength-duration curves and chronaxies of the HB and of the adjacent right ventricular (RV) working myocardium and to analyze zones of selective HB capture and battery current drain when pacing at different pulse durations (PDs).METHODS Consecutive patients with permanent HB pacing were studied. The RV and HB capture thresholds were assessed at several PDs. Battery current drain and zones of selective HB capture at PDs of 0.1, 0.2, 0.4, and 1.0 ms were determined. RESULTSIn the whole group (N 5 127), the HB chronaxie was shorter than the RV chronaxie. This difference was driven by patients with selective HB pacing (HB chronaxie 0.47 ms vs RV chronaxie 0.79 ms). The strength-duration curve for the HB had a lower rheobase and its steep portion started at shorter PDs, thus creating wider distance-zone of programmable selective HB pacing-between the HB and RV strength-duration curves at shorter PDs. The battery current drain was lower with pacing at PDs of 0.1-0.4 ms vs 1.0 ms. Chronaxie-adjusted PDs offered the lowest current drain.CONCLUSION For the first time, the strength-duration curves for permanent selective and nonselective HB pacing were determined. Selective HB capture and battery longevity can be promoted by shorter PDs (0.2 ms). Longer PDs (1.0 ms) offer greater safety margin for RV capture and may be preferable if simultaneous RV capture during HB pacing is desired.

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Long Pacing Pulses Reduce Phrenic Nerve Stimulation in Left Ventricular Pacing

Abstract: Long pulse durations lead to a decreased threshold of the heart relatively to the phrenic nerve and may prevent stimulation of the phrenic nerve in a clinical setting.

Cited by 13 publications

References 18 publications

Cardiac Resynchronization Therapy: Extending Current Responses to Phrenic Nerve Stimulation

Cardiac Resynchronization Therapy: Extending Current Responses to Phrenic Nerve Stimulation

Percutaneous Epicardial Pacing Using a Novel Insulated Multi-Electrode Lead

His bundle has a shorter chronaxie than does the adjacent ventricular myocardium: Implications for pacemaker programming

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