Phrenic stimulation: a challenge for cardiac resynchronization therapy.

Details

Serval ID
serval:BIB_CC0042B133DC
Type
Article: article from journal or magazin.
Collection
Publications
Title
Phrenic stimulation: a challenge for cardiac resynchronization therapy.
Journal
Circulation. Arrhythmia and electrophysiology
Author(s)
Biffi M., Moschini C., Bertini M., Saporito D., Ziacchi M., Diemberger I., Valzania C., Domenichini G., Cervi E., Martignani C., Sangiorgi D., Branzi A., Boriani G.
ISSN
1941-3084 (Electronic)
ISSN-L
1941-3084
Publication state
Published
Issued date
08/2009
Peer-reviewed
Oui
Volume
2
Number
4
Pages
402-410
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Phrenic stimulation (PS) may hinder left ventricular (LV) pacing. We prospectively observed its prevalence in consecutive patients with cardiac resynchronization therapy (CRT) devices.
In the years 2003 to 2006, 197 patients received a CRT device. PS and LV threshold measurements were carried out at implantation and at 6-month follow-up. LV reverse remodeling was assessed by echocardiography before implantation and at follow-up. LV lead placement was lateral/posterolateral in 86% of patients. Both PS and LV reverse remodeling occurred most frequently at the lateral/posterolateral LV pacing sites (P<0.001). PS was detected in 73 (37%) of patients and was clinically relevant in 41 (22%). The detection of PS at implantation had a poor sensitivity, as it occurred only in left lateral or sitting position in 27 patients. Ten patients (5%) underwent repeated surgery and 4 (2%) had their CRT turned off because of PS. At follow-up, we could manage PS noninvasively in 32 patients with a small PS-LV threshold difference: in 20 by cathode programmability (3 also thanks to automatic management of LV output) and in 12 (without cathode programmability) by programming the LV output as threshold +1 V.
PS may seriously hinder CRT. A bipolar LV lead and cathode programmability are mandatory to avoid PS by changing the LV pacing vector at target sites for CRT. LV stability at target sites despite PS should also be pursued by these means. The automatic adjustment of LV pacing output is complementary in patients with a small PS-LV threshold difference.
Keywords
Aged, Arrhythmias, Cardiac/diagnostic imaging, Arrhythmias, Cardiac/epidemiology, Arrhythmias, Cardiac/therapy, Cardiac Pacing, Artificial/adverse effects, Cardiac Pacing, Artificial/methods, Cardiac Pacing, Artificial/statistics & numerical data, Echocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Phrenic Nerve/physiopathology, Predictive Value of Tests, Prevalence, Ventricular Dysfunction, Left/diagnostic imaging, Ventricular Dysfunction, Left/epidemiology, Ventricular Dysfunction, Left/etiology
Pubmed
Web of science
Open Access
Yes
Create date
03/03/2024 19:10
Last modification date
11/03/2024 8:17
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