Feasibility of cathodic‐anodal left ventricular stimulation for alternative multisite pacing. Issue 6 (30th April 2018)

• Record Type: Journal Article
• Authors: Dell'Era, Gabriele; De Vecchi, Federica; Prenna, Eleonora; Devecchi, Chiara; Degiovanni, Anna; Malacrida, Maurizio; Magnani, Andrea; Occhetta, Eraldo; Marino, Paolo
• Is Part Of: Pacing and clinical electrophysiology. Volume 41:Issue 6(2018)
• Page Start: 597
• Page End: 602
• Publication Date: 2018-04-30
• Subjects: anodal stimulation -- multisite pacing -- resynchronization therapy -- surface ECG; Cardiac pacing -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1111/pace.13344
• Languages: English
• ISSNs: 0147-8389

Abstract

Abstract: 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.