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Effect of Bipolar Electrode Spacing on Phrenic Nerve Stimulation and Left Ventricular Pacing Thresholds: An Acute Canine Study.
MedLine Citation:
PMID:  22787012     Owner:  NLM     Status:  Publisher    
BACKGROUND: -Phrenic Nerve Stimulation (PNS) is a common complication of cardiac resynchronization therapy (CRT) when left ventricular (LV) pacing occurs via a coronary vein. The purpose of this study was to evaluate effects of bipolar electrode spacing on PNS and LV pacing threshold. METHODS AND RESULTS: -Electrophysiology (EP) catheters with standard (2mm-5mm-2mm) or modified (1mm-5mm-1mm) inter-electrode spacing was respectively inserted in a posterior/lateral cardiac vein in a randomized order in six anesthetized dogs via jugular access. The phrenic nerve was dissected via a left mini-thoracotomy and repositioned over the vein, as close as possible to one of the electrodes. The presence of PNS was verified (i.e. PNS threshold <2V at 0.5 ms in unipolar configuration). Bipolar pacing was delivered using the electrode closest to the phrenic nerve as the cathode, and multiple bipolar electrode spacing configurations were tested. During bipolar pacing, PNS threshold increased as bipolar electrode spacing was reduced (p<0.05), while LV pacing thresholds did not change significantly (p>0.05). Compared with a standard bipolar electrode spacing of 20mm for LV leads, 1mm and 2mm bipolar electrode spacing resulted in a PNS threshold increase of 5.5±2.2V (p=0.003) and 2.8±1.7V (p<0.001), respectively. Similarly, PNS threshold increased by 6.5±3.7V with 1mm and by 3.8±1.9V with 2mm bipolar pacing (both p<0.001), as compared to unipolar pacing. CONCLUSIONS: -This study suggests that reducing LV bipolar electrode spacing from the standard 20 mm to 1 or 2 mm may significantly increase the PNS threshold without compromising LV pacing thresholds.
Mauro Biffi; Laurie Foerster; William Eastman; Michael Eggen; Nathan A Grenz; John Sommer; Tiziana De Santo; Tarak Haddad; Annamaria Varbaro; Zhongping Yang
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-7-11
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  -     ISSN:  1941-3084     ISO Abbreviation:  -     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-7-12     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1 University of Bologna, Bologna, Italy;
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