Super-response to cardiac resynchronization therapy may predict late phrenic nerve stimulation. Issue 9 (22nd November 2017)

• Record Type: Journal Article
• Authors: Juliá, Justo; López-Gil, María; Fontenla, Adolfo; Lozano, Álvaro; Villagraz, Lola; Salguero, Rafael; Arribas, Fernando
• Is Part Of: Europace. Volume 20:Issue 9(2018)
• Page Start: 1498
• Page End: 1505
• Publication Date: 2017-11-22
• Subjects: Cardiac resynchronization therapy Phrenic nerve stimulation Super-response Follow-up Complication; Arrhythmia -- Treatment -- Periodicals; Cardiac pacing -- Periodicals; Catheter ablation -- Periodicals; Heart -- Physiology -- Periodicals; Electrophysiology -- Periodicals; 617.4120645
• DOI: 10.1093/europace/eux311
• Languages: English
• ISSNs: 1099-5129

Abstract

Abstract: Aims : Changes in the anatomical relationship between left phrenic nerve and coronary veins may occur due to the reverse remodelling observed in super-responders to cardiac resynchronization therapy (CRT) and might be the underlying mechanism in patients developing late-onset phrenic nerve stimulation (PNS) without evidence of lead dislodgement (LD). In this study, we sought to evaluate the role of super-response (SR) to CRT as a potential predictor of late-onset PNS. Methods and results: Consecutive patients implanted with a left ventricular (LV) lead in a single centre were retrospectively analysed. Phrenic nerve stimulation was classified as 'early' when it occurred within 3 months of implantation and 'late' for occurrences thereafter. 'Late' PNS was considered related to LD (LD–PNS) when LV threshold differed by > 1 V or impedance >250 Ω from baseline values or in case of radiological displacement. Cases not meeting the former criteria were classified as 'non-LD–PNS'. Super-response was defined as a decrease ≥30% of the left ventricluar end-systolic volume at 1-year echocardiography. At 32 ± 7 months follow-up, PNS occurred in 20 of 139 patients. Late non-LD–PNS incidence was significantly higher in the SR group (8/61; 13.1%) when compared with the non-SR (1/78; 1.3%) ( P = 0.010). Super-response remained the only predictor of non-LD–PNS at multivariate analysis (odds ratio: 11.62, 95% confidence interval 1.41–95.68, P = 0.023). Conclusion: Incidence of late non-LD–PNS is higher among SR to CRT, suggesting a potential role of the changes in the anatomical relationship between left phrenic nerve and coronary veins.