| Potential proarrhythmic effect of biventricular pacing: fact or myth? | |
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MedLine Citation:
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PMID: 16171749 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Hemodynamic improvement from biventricular pacing is well documented; however, its electrophysiologic effects have not been systematically studied. Sporadic case reports suggest a proarrhythmic effect of biventricular pacing resulting primarily in polymorphic ventricular tachycardia/ventricular fibrillation (VT/VF). OBJECTIVES: The purpose of this study was to report a series of patients in whom implantation of a biventricular system resulted in VT/VF storm with predominance of monomorphic VT. METHODS: In a retrospective analysis of all biventricular implants over a 4-year period at a single medical center, we identified 5 of 145 patients (3.4%) who developed VT/VF after they were upgraded to a biventricular system. All patients were male, age 71 +/- 8 years, with ejection fraction of 0.25 +/- 0.1. Four of five patients had ischemic cardiomyopathy. RESULTS: All patients developed incessant VT/VF within 1 week of implantation. Monomorphic VT of single morphology was noted in 3 of 5 patients, monomorphic VT of multiple morphologies in 1, and polymorphic VT/VF in 1. VT was managed by temporary discontinuation of biventricular pacing in all patients, amiodarone in 3 of 5, sotalol in 1, and beta-blocker in 1. During 11 +/- 7 months of follow-up, 4 of 5 patients remain alive and are arrhythmia-free. CONCLUSION: Biventricular pacing may result in precipitation of VT/VF storm in a minority of patients with prior history of VT/VF. This may be the first case series reporting both monomorphic and polymorphic VT after an upgrade to a system with biventricular pacing capabilities. The arrhythmias can be managed by conventional therapy and may require temporary discontinuation of left ventricular pacing. This observation is relevant to patients receiving a biventricular pacemaker without an implantable cardioverter-defibrillator backup. |
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Authors:
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Gunjan Shukla; G Muqtada Chaudhry; Michael Orlov; Peter Hoffmeister; Charles Haffajee |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Heart rhythm : the official journal of the Heart Rhythm Society Volume: 2 ISSN: 1547-5271 ISO Abbreviation: Heart Rhythm Publication Date: 2005 Sep |
Date Detail:
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Created Date: 2005-09-20 Completed Date: 2006-06-06 Revised Date: 2009-10-27 |
Medline Journal Info:
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Nlm Unique ID: 101200317 Medline TA: Heart Rhythm Country: United States |
Other Details:
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Languages: eng Pagination: 951-6 Citation Subset: IM |
Affiliation:
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St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA. gunjanshukla@hotmail.com |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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therapeutic use Aged Amiodarone / therapeutic use Anti-Arrhythmia Agents / therapeutic use Atrial Fibrillation / therapy Cardiac Pacing, Artificial* Defibrillators, Implantable Electrocardiography Electrophysiologic Techniques, Cardiac Humans Male Middle Aged Retrospective Studies Sotalol / therapeutic use Tachycardia, Ventricular / drug therapy, therapy* Treatment Outcome Ventricular Fibrillation / drug therapy, therapy* |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone; 3930-20-9/Sotalol |
| Comments/Corrections | |
Comment In:
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Heart Rhythm. 2005 Sep;2(9):957-9
[PMID:
16171750
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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