Long-Term Performance of Right Ventricular Implantable Cardioverter-Defibrillator Leads in Arrhythmogenic Right Ventricular Cardiomyopathy and Hypertrophic Cardiomyopathy

Sagawa, Yuichiro; Nagata, Yasutoshi; Yamaguchi, Tetsuo; Mitsui, Kentaro; Nagamine, Tatsuhiro; Yamaguchi, Junji; Hijikata, Sadahiro; Watanabe, Keita; Masuda, Ryosuke; Miyazaki, Ryoichi; Kaneko, Masakazu; Miwa, Naoyuki; Sekigawa, Masahiro; Hara, Nobuhiro; Nozato, Toshihiro; Ashikaga, Takashi; Goya, Masahiko; Sasano, Tetsuo; Hirao, Kazuyuki

doi:10.1536/ihj.19-279

Cited by 5 publications

(3 citation statements)

References 30 publications

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“… 9 In ARVC, progressive myocardium loss causes significant deterioration in R-wave sensing and defects in VT/VF detection. 5 , 10 Taleski et al 6 have implanted a trans-CS LV lead to enhance the ICD sensing in an ARVC patient, but it is challenging due to right heart enlargement and unstable contact with the epicardial myocardium to maintain sufficient R-wave sensing. In contrast, LBBAP was confirmed to produce more stable and excellent performance.…”

Section: Discussionmentioning

confidence: 99%

“… 4 However, progressive myocardium loss deteriorates the defibrillation lead’s sensing ability, causing unsuccessful or inappropriate delivery of ICD therapy and even death. 5 A case report has demonstrated the feasibility of a trans-coronary sinus (trans-CS) left ventricular (LV) lead in improving ICD’s R-wave sensing. 6 In recent years, left bundle branch area pacing (LBBAP) was popularized, including left bundle branch pacing and left ventricular septal pacing (LVSP).…”

Section: Introductionmentioning

confidence: 99%

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Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Chen

Dai

et al. 2022

European Heart Journal - Case Reports

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Background Implantable cardioverter-defibrillator (ICD) implantation is a key therapeutic option in arrhythmogenic right ventricular cardiomyopathy (ARVC) to prevent sudden cardiac death due to ventricular tachycardia (VT) and fibrillation (VF). However, sub-optimized R-wave sensing due to myocardium loss interferes with VT/VF identification and appropriate therapy. We tried to implant a 3830 lead to the left ventricular septum (LVS) to facilitate ICD sensing in an ARVC patient. Case summary A 68-year-old woman diagnosed with ARVC was scheduled to undergo ICD implantation. Initially, no sites with suitable R-wave amplitudes were found in the right ventricle (RV) to deploy the defibrillation lead (<3.0 mV). It was likely due to severe RV involvement, but the LVS myocardium was more preserved based on cardiac magnetic resonance imaging. Therefore, we implanted a 3830 lead into the deep area of the septum to facilitate R-wave sensing. During the procedure from the right to left septum, the R-wave amplitude significantly increased (2.6 mV to 4.3∼7.1 mV). LVS pacing was finally achieved with favorable R-wave sensing (9.9 mV 24 hours post-operation). The 3830 lead was plugged into the IS-1 port, while the defibrillation lead was plugged into the DF-1 port. After a four-month follow-up, the R-wave amplitude of the 3830 lead was 11.1 mV. Discussion When the R-wave sensing is not acceptable for ICD implantation in ARVC patients, it is critical to assess myocardial conditions comprehensively. If the septal myocardium is preserved, implanting a 3830 lead to the deep or left ventricular septum is feasible to improve R-wave sensing.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Chen

Dai

et al. 2022

European Heart Journal - Case Reports

View full text Add to dashboard Cite

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“…A progressive reduction in R-wave amplitude at the intracavitary EGM is a known phenomenon in ACM patients, particularly in ARVC patients, and it is attributed to progressive myocardial fibro-fatty replacement. Low sensing values in the right ventricle may exist already at the time of implantation and progressive decline of signal amplitude together with increased pacing threshold may occur [ 115 , 116 , 117 ]. In this study we reported complications needing reintervention in 9 patients (12.5%), of whom 3 (4.2%) had loss of adequate sensing, despite a strategy to target an RV septal location.…”

Section: Discussionmentioning

confidence: 99%

The Challenges of Diagnosis and Treatment of Arrhythmogenic Cardiomyopathy: Are We there yet?

Spadotto¹,

Morabito²,

Carecci³

et al. 2022

Rev. Cardiovasc. Med.

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Background: we sought to review the evolution in the diagnosis and treatment of Arrhythmogenic Cardiomyopathy (ACM), a clinically multifaceted entity beyond the observation of ventricular arrhythmias, and the outcome of therapies aiming at sudden death prevention in a single center experience. Methods: retrospective analysis of the data of consecutive patients with an implanted cardioverter-defibrillator (ICD) and a confirmed diagnosis of ACM according to the proposed Padua Criteria, who were referred to our center from January 1992 to October 2021. Results: we enrolled 72 patients (66% males, mean age at implant 46 ± 16 years), 63.9% implanted for primary prevention. At the time of ICD implant, 29 (40.3%) patients had a right ventricular involvement, 24 (33.3%) had a dominant LV involvement and 19 (26.4%) had a biventricular involvement. After a median follow-up of 6,1 years [IQR: 2.5-9.9], 34 patients (47.2%) had 919 sustained episodes of ventricular arrhythmias (VA). 27 patients (37.5%) had 314 episodes of life-threatening arrhythmias (LT-VA), defined as sustained ventricular tachycardia ≥200 beats/min. Considering only the patients with an ICD capable of delivering ATP, 80.4% of VA and 65% of LT-VA were successfully terminated with ATP. 16 (22.2%) patients had an inappropriate ICD activation, mostly caused by atrial fibrillation, while in 9 patients (12.5%) there was a complication needing reintervention (in 3 cases there was a loss of ventricular sensing dictating lead revision). During the follow-up 11 (15.3%) patients died, most of them due to heart failure, and 8 (11.1%) underwent heart transplantation. Conclusions: ACM is increasingly diagnosed owing to heightened suspicion at ECG examination and to improved imaging technology and availability, though the diagnostic workflow is particularly challenging in the earliest disease stages. ICD therapy is the cornerstone of sudden death prevention, albeit its efficacy is not based on controlled studies, and VT ablation/medical therapy are complementary to this strategy. The high burden of ATP-terminated VA makes shock-only devices debatable. The progressive nature of ACM leads to severe biventricular enlargement and refractory heart failure, which pose significant treatment issues when a predominant RV dysfunction occurs owing to the reduced possibility for mechanical circulatory assistance.

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The Value of Strain Echocardiography in Predicting Electrical Progression in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

Hosseini

Rezaeian

Sadeghpour

et al. 2023

Texas Heart Institute Journal

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Background Arrhythmogenic right ventricular (RV) cardiomyopathy is a progressive disease characterized by the replacement of the normal myocardium with fibrofatty tissue. This study aimed to determine the value of echocardiographic RV deformation parameters in predicting electrical progression as assessed by serial changes in RV lead sensing and threshold in patients with arrhythmogenic RV cardiomyopathy. Methods The present study recruited 40 patients with a definitive diagnosis of arrhythmogenic RV cardiomyopathy at a mean (SD) age of 38.6 (14.2) years between 2018 and 2020. All patients had received an implantable cardioverter-defibrillator for the primary or secondary prevention of sudden cardiac death. The patients underwent 2-dimensional (2D) and 3-dimensional (3D) transthoracic echocardiographic examinations and RV 2D and 3D strain analyses, comprising free-wall longitudinal strain, global longitudinal strain, and strain rate. They were then followed up for electrical progression. Results During a mean (SD) follow-up period of 20 (6) months, the RV lead amplitude decreased from 7.95 (IQR, 4.53-10.25) mV to 5.25 (IQR, 2.88-8.55) mV (P < .001), and the lead threshold increased from 0.75 (IQR, 0.50-0.79) V to 0.75 (IQR, 0.75-1.00) V (P < .001). Right ventricular 2D free-wall (ρ = 0.56, P = .01), RV 2D global (ρ = 0.58, P = .007), and RV 3D free-wall (ρ = 0.65; P = .003) longitudinal strain correlated with electrical progression. Conclusion Right ventricular 2D and 3D deformation parameters were found to be significant predictors of electrical progression during follow-up of patients with arrhythmogenic RV cardiomyopathy. These findings suggest that echocardiography has a pivotal role in predicting patients at high risk for electrical progression.

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Long-Term Performance of Right Ventricular Implantable Cardioverter-Defibrillator Leads in Arrhythmogenic Right Ventricular Cardiomyopathy and Hypertrophic Cardiomyopathy

Cited by 5 publications

References 30 publications

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

Additional left ventricular septal lead facilitates R-wave sensing of implantable cardioverter-defibrillator in arrhythmogenic right ventricular cardiomyopathy: a case report

The Challenges of Diagnosis and Treatment of Arrhythmogenic Cardiomyopathy: Are We there yet?

The Value of Strain Echocardiography in Predicting Electrical Progression in Patients With Arrhythmogenic Right Ventricular Cardiomyopathy

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