Document Detail


Potential proarrhythmic effect of biventricular pacing: fact or myth?
MedLine Citation:
PMID:  16171749     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Gunjan Shukla; G Muqtada Chaudhry; Michael Orlov; Peter Hoffmeister; Charles Haffajee
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
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:
Created Date:  2005-09-20     Completed Date:  2006-06-06     Revised Date:  2009-10-27    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  951-6     Citation Subset:  IM    
Affiliation:
St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02135, USA. gunjanshukla@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / 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:
0/Adrenergic beta-Antagonists; 0/Anti-Arrhythmia Agents; 1951-25-3/Amiodarone; 3930-20-9/Sotalol
Comments/Corrections
Comment In:
Heart Rhythm. 2005 Sep;2(9):957-9   [PMID:  16171750 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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