Potential Proarrhythmic Effects of Biventricular Pacing
| Autor: | Charles Antzelevitch, Josep Brugada, Jeffrey M. Fish |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Cardiac output medicine.medical_treatment Cardiac resynchronization therapy QT interval Ventricular Function Left Article Electrocardiography Internal medicine Animals Humans Medicine Repolarization cardiovascular diseases Endocardium medicine.diagnostic_test business.industry Cardiac Pacing Artificial Arrhythmias Cardiac medicine.disease Heart failure Anesthesia Circulatory system cardiovascular system Cardiology Cardiology and Cardiovascular Medicine business Pericardium |
| Zdroj: | Journal of the American College of Cardiology. 46:2340-2347 |
| ISSN: | 0735-1097 |
| Popis: | Resynchronization therapy involving right ventricular endocardial and left ventricular epicardial pacing improves cardiac output, quality of life, and New York Heart Association functional class in patients with congestive heart failure. Although a great deal of attention has been directed at showing the mechanical benefits and in fine-tuning the biventricular pacing configuration and protocol, little attention has been focused on the consequences of reversing the direction of activation of the left ventricular wall. Recent basic science and clinical studies have shown a proarrhythmic effect of reversing the direction of activation of the left ventricular wall. Reversal of the normal activation sequence prolongs the QT interval and increases the existing transmural dispersion of repolarization, creating the substrate and trigger for re-entrant arrhythmias under long QT conditions. A number of case reports of R-on-T extrasystoles and ventricular tachyarrhythmia induction as a result of biventricular pacing support this observation, and raise concern that biventricular pacing may be proarrhythmic in select cases, particularly when associated with a prolonged QT interval. Our focus in this review is on current understanding of transmural heterogeneity of repolarization that exists across the left ventricular wall, how this dispersion of repolarization is amplified as a consequence of reversal of the normal activation sequence, and how these basic experimental findings may apply to patients receiving cardiac resynchronization therapy. |
| Databáze: | OpenAIRE |
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