Potential Proarrhythmic Effects of Biventricular Pacing
Key result
Biventricular pacing may trigger arrhythmias by prolonging QT intervals and increasing transmural dispersion of repolarization.
Why the study?
Little attention has been focused on the electrophysiological and potential proarrhythmic consequences of reversing the direction of left ventricular wall activation during biventricular pacing.
Does biventricular pacing cause proarrhythmic effects in patients with congestive heart failure?
Design
Review
Authors
Discussion
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Implication
Reversing ventricular activation direction in resynchronization may affect outcomes; leaves open optimal pacing protocols in heart failure.
Key Points
- Examine how biventricular pacing and reversal of left ventricular activation affect transmural dispersion of repolarization and promote ventricular arrhythmogenesis.
- Reviewed basic experimental literature and clinical reports investigating the electrophysiological consequences of left ventricular epicardial pacing.
- Analyzed the effects of altered electrical activation pathways on the QT interval and transmural heterogeneity of repolarization.
- Reversing the normal left ventricular activation sequence prolongs the QT interval and amplifies transmural dispersion of repolarization across the myocardial wall.
- Increased repolarization dispersion creates the substrate and trigger for re-entrant ventricular tachyarrhythmias and R-on-T extrasystoles, especially in patients with preexisting long QT conditions.
Structured PICO
Does biventricular pacing cause proarrhythmic effects in patients with congestive heart failure?
P
Population
Patients with congestive heart failure receiving cardiac resynchronization therapy.
I
Intervention
Biventricular pacing (right ventricular endocardial and left ventricular epicardial pacing)
O
Outcome
Proarrhythmic effects (prolongation of QT interval, increased transmural dispersion of repolarization, ventricular tachyarrhythmia)safety
Biventricular pacing may have proarrhythmic effects by reversing the normal activation sequence, prolonging the QT interval, and increasing transmural dispersion of repolarization.
Cite This Study
Fish et al. (2005) conducted a review in Congestive heart failure. Biventricular pacing was evaluated on Proarrhythmic effects (prolonged QT interval, transmural dispersion of repolarization, ventricular tachyarrhythmia). Biventricular pacing may have proarrhythmic effects by prolonging the QT interval and increasing transmural dispersion of repolarization, potentially triggering re-entrant arrhythmias.