Ventricular Tachycardia Induced by Biventricular Pacing in Patient with Severe Ischemic Cardiomyopathy

Mykytsey, Andrew; Maheshwari, Piyush; Dhar, Gaurav; Razminia, Mansour; Zheutlin, Terry; Wang, Ted; Kehoe, Richard F.

doi:10.1111/j.1540-8167.2005.40764.x

Cited by 58 publications

(50 citation statements)

References 12 publications

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“…7 Although suppression of recurrent VT with catheter ablation has been reported, 7,8 treatment most often required inactivation of LV pacing, depriving these patients of the beneficial effects of resynchronization. 5,6 Prognosis is poor, even after control of recurrent VT, with a 50% mortality rate and frequent progression to refractory HF. 7 …”

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confidence: 99%

“…3 Despite this, CRT-induced proarrhythmia has been reported as a clinically serious, rare, and unpredictable phenomenon. [4][5][6][7] Patients usually present with recurrent sustained ventricular tachycardia (VT)/electrical storm (ES), refractory to antiarrhythmic drugs, often accompanied with HF deterioration and cardiogenic shock. 7 Although suppression of recurrent VT with catheter ablation has been reported, 7,8 treatment most often required inactivation of LV pacing, depriving these patients of the beneficial effects of resynchronization.…”

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confidence: 99%

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Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation

Roque

Trevisi

Silberbauer

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-The mechanism of cardiac resynchronization therapy (CRT)-induced proarrhythmia remains unknown. We postulated that pacing from a left ventricular (LV) lead positioned on epicardial scar can facilitate re-entrant ventricular tachycardia. The aim of this study was to investigate the relationship between CRT-induced proarrhythmia and LV lead location within scar. Methods and Results-Twenty-eight epicardial and 63 endocardial maps, obtained from 64 CRT patients undergoing ventricular tachycardia ablation, were analyzed. A positive LV lead/scar relationship, defined as a lead tip positioned on scar/border zone, was determined by overlaying fluoroscopic projections with LV electroanatomical maps. CRTinduced proarrhythmia occurred in 8 patients (12.5%). They all presented early with electrical storm (100% versus 39% of patients with no proarrhythmia; P<0.01), requiring temporary biventricular pacing discontinuation in half of cases. They more frequently presented with heart failure/cardiogenic shock (50% versus 7%; P<0.01), requiring intensive care management. Ventricular tachycardia was re-entrant in all. The LV lead location within epicardial scar was significantly more frequent in the proarrhythmia group (60% versus 9% P=0.03 on epicardial bipolar scar, 80% versus 17% P=0.02 on epicardial unipolar scar, and 80% versus 17% P=0.02 on any-epicardial scar). Ablation was performed within epicardial scar, close to the LV lead, and allowed CRT reactivation in all patients. Conclusions-CRT-induced proarrhythmia presented early with electrical storm and was associated with an LV lead positioning within epicardial scar. Catheter ablation allowed for resumption of biventricular stimulation in all patients. (Circ Arrhythm Electrophysiol. 2014;7:1064-1069.)

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confidence: 99%

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confidence: 99%

Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation

Roque

Trevisi

Silberbauer

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…In several reported studies, monomorphic or polymorphic ventricular tachycardia (VT) was shown to be induced by BVP [18][19][20][21] , but in several other studies, CRT was shown to have an antiarrhythmic effect [22][23][24][25][26] . Experimental studies have shown that left ventricular epicardial pacing and BVP increase the QT and JT intervals and transmural dispersion of repolarization by altering the transmural sequence of activation of the intrinsically heterogeneous ventricular myocardium 7,8) .…”

Section: Discussionmentioning

confidence: 99%

Influence of Pacing Modes on Microvolt T-Wave Alternans

Hashimoto

Watanabe

Kasamaki

et al. 2014

Nichidai Igaku Zasshi

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Objective: Cardiac resynchronization therapy (CRT) is known to be effective for left ventricular dysfunction associated with left bundle branch block. However, CRT does not necessarily decrease the risk of sudden cardiac death. Recent studies have shown that epicardial left ventricular pacing may lead to prolongation of the QT interval and the development of torsades de pointes. Microvolt T-wave alternans (TWA) has been associated with increased susceptibility to ventricular tachyarrhythmias. We compared the influence of right atrial pacing, right ventricular pacing, left ventricular pacing and biventricular pacing (RAP, RVP, LVP and BVP) on TWA.Methods: TWA was measured per pacing mode during incremental pacing from 70 to 120 bpm in 18 CRT patients with a mean ejection fraction of 32±5%. TWA was considered positive if alternans voltage (Valt)＞1.9 μV and alternans ratio (AR)＞3.0 were observed for at least 1 minute. The incidence of TWA is reported as the percentage of impulse applications during which it was observed.Results: TWA was observed as follows: BVP, 73%; RVP, 50%; LVP, 60%; and RAP, 60%. Mean Valt (μV) was 2. 44±0.35, 0.36±0.11, 1.44±0.65, and 1.95±0.45, respectively (P＜0.01 BVP vs. RVP). Mean alternans ratio during BVP, RVP, LVP, and RAP was 8.21±2.4, 4.28±1.3, 5.66±2.3, and 7.36±2.0, respectively (P＜0.05 BVP vs. RVP).Conclusion: BVP may increase the temporal inhomogeneity of ventricular repolarization, which may lead to the development of ventricular tachyarrhythmia.

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“…[50][51][52] Paradoxically, there also has been several case reports of ventricular arrhythmia storm post cardiac resynchronization therapy, either de novo implants or upgrades. [53][54][55] The mechanism of arrhythmia storm has been speculated to be related to the heterogeneous transmural repolarization across the ventricle 56 and possible concealment related to left or bi-ventricular pacing. The programmed pacing from the left ventricular lead of the resynchronization device has been reported to reinitate reentrant ventricular tachyarrhythmias by concealment into a potential VT circuit antidromically setting up conditions allowing for propagation of the wavefront orthodromically within the VT circuit.…”

Section: Cardiac Resynchronization Therapy and Es Eventsmentioning

confidence: 99%

Electrical Storm in the Era of Implantable Cardioverter Defibrillators

Huang¹,

Traub²

2011

Cardiac Defibrillation - Prediction, Prevention and Management of Cardiovascular Arrhythmic Events

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Ventricular Tachycardia Induced by Biventricular Pacing in Patient with Severe Ischemic Cardiomyopathy

Abstract: This case represents a clear example of CRT induced proarrhythmia, which required inactivation of LV pacing for effective acute management. Such an intervention should be considered in CRT patients who exhibit a notable increase in drug refractory VT episodes.

Cited by 58 publications

References 12 publications

Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation

Electrical Storm Induced by Cardiac Resynchronization Therapy Is Determined by Pacing on Epicardial Scar and Can be Successfully Managed by Catheter Ablation

Influence of Pacing Modes on Microvolt T-Wave Alternans

Electrical Storm in the Era of Implantable Cardioverter Defibrillators

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