Transseptal Left Ventricular Endocardial Pacing Reduces Dispersion of Ventricular Repolarization

Autor:	Edd Watts, Arthur M. Yue, Mehmood Zeb, Paul A. Scott, Paul R. Roberts, John M. Morgan
Rok vydání:	2011
Předmět:	Proarrhythmia Ventricular Repolarization medicine.medical_specialty business.industry Epicardial pacing medicine.medical_treatment Cardiac resynchronization therapy General Medicine medicine.disease QT interval Internal medicine Heart failure cardiovascular system medicine Cardiology Repolarization cardiovascular diseases Cardiology and Cardiovascular Medicine business Coronary sinus
Zdroj:	Pacing and Clinical Electrophysiology. 34:1258-1266
ISSN:	0147-8389
DOI:	10.1111/j.1540-8159.2011.03138.x
Popis:	Background: ?Cardiac resynchronization therapy (CRT) may be proarrhythmic in some patients. This may be due to the effect of left ventricular (LV) epicardial pacing on ventricular repolarization. The purpose of this study was to evaluate the effect of endocardial versus epicardial LV biventricular pacing on surface electrocardiogram (ECG) parameters that are known markers of arrhythmogenic repolarization. Methods: ?ECG markers of repolarization (QT dispersion, QTD; T peak to end, T(peak-end) ; T(peak-end) dispersion, T(peak-end) D; QTc) were retrospectively measured before and after CRT in seven patients with transseptal LV endocardial leads (TS group), 28 matched patients with coronary sinus (CS) LV leads (CS group), and eight patients with surgical LV epicardial leads (SUR group). All ECGs were scanned and analyzed using digital callipers. Results: ?Compared to the CS group, the TS group CRT was associated with a significant postpacing reduction in QTD (-45.2 ± 35.6 vs -4.3 ± 43.6 ms, P = 0.03) and T(peak-end) (-24.2 ± 22.1 vs 3.4 ± 26.7 ms, P = 0.02). There was a nonsignificant post-CRT reduction in both T(peak-end) D (-11.3 ± 31.0 vs 2.4 ± 28.9 ms, P = 0.27) and QTc (-50.0 ± 46.4 vs 4.4 ± 70.2 ms, P = 0.06) in the TS versus the CS group. In contrast, there were no differences between the SUR and CS groups in terms of the effect of CRT on these repolarization parameters. Conclusions: ?CRT with (atrial transseptal) endocardial LV lead placement is associated with repolarization characteristics that are considered to be less arrhythmogenic than those generated by CS (epicardial) LV lead placement. Further work is needed to determine whether these changes translate to a reduction in proarrhythmia.
Databáze:	OpenAIRE
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