Key result
Cathodic-anodal biventricular stimulation is feasible, achieving anodal capture in 28 of 30 patients and producing similar QRS wavefront activation to multipoint pacing in 90% of patients.
Why the study?
Is cathodic-anodal left ventricular stimulation feasible and how does its QRS wavefront activation compare to conventional multipoint pacing in patients undergoing CRT?
Observational (n=30)
Is cathodic-anodal left ventricular stimulation feasible and how does its QRS wavefront activation compare to conventional multipoint pacing in patients undergoing CRT?
Cathodic-anodal left ventricular stimulation is feasible and produces similar QRS wavefront activation to multipoint pacing, offering an alternative approach for CRT.
May offer CRT alternative to multipoint pacing; leaves open outcome benefits in randomized trials.
BACKGROUND: Simultaneous cathodic-anodal capture by a bipole of a cardiac resynchronization therapy (CRT) left-ventricular (LV) catheter may depolarize a larger LV area than conventional multipoint pacing. We evaluated the feasibility of cathodic-anodal LV stimulation. METHODS: In 30 patients undergoing CRT with a quadripolar LV lead, we evaluated the cathodic and anodal capture threshold for each LV pole and compared QRS on electrocardiogram (ECG) during single-point cathodic biventricular stimulation (S-BS), multipoint BS (M-BS), and cathodic-anodal BS (CA-BS). RESULTS: Anodal capture was obtained by three poles in 23/30 patients, by two poles in five, and was not feasible in two. The mean single-point anodal threshold was 3.93 V versus single-point cathodic threshold of 1.95 V. On comparing ECGs, M-BS and CA-BS produced similar QRS wavefront activation in 90% of patients. CONCLUSIONS: CA-BS is feasible and may be used in LV pacing to achieve a different wavefront of electrical activation. Further prospective studies are needed in order to verify the clinical impact of this kind of stimulation.
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Dell’Era et al. (2018) conducted an observational in Patients undergoing cardiac resynchronization therapy (n=30). Cathodic-anodal biventricular stimulation (CA-BS) vs. Single-point cathodic biventricular stimulation (S-BS) and multipoint BS (M-BS) was evaluated on Feasibility of cathodic-anodal LV stimulation (anodal capture threshold and QRS wavefront activation). Cathodic-anodal biventricular stimulation is feasible, achieving anodal capture in 28 of 30 patients and producing similar QRS wavefront activation to multipoint pacing in 90% of patients.
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