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Transseptal Left Ventricular Endocardial Pacing Reduces Dispersion of Ventricular Repolarization.
MedLine Citation:
PMID:  21615758     Owner:  NLM     Status:  Publisher    
Background:  Cardiac resynchronization therapy (CRT) may be proarrhythmic in some patients. This may be due to the effect of left ventricular (LV) epicardial pacing on ventricular repolarization. The purpose of this study was to evaluate the effect of endocardial versus epicardial LV biventricular pacing on surface electrocardiogram (ECG) parameters that are known markers of arrhythmogenic repolarization. Methods:  ECG markers of repolarization (QT dispersion, QTD; T peak to end, T(peak-end) ; T(peak-end) dispersion, T(peak-end) D; QTc) were retrospectively measured before and after CRT in seven patients with transseptal LV endocardial leads (TS group), 28 matched patients with coronary sinus (CS) LV leads (CS group), and eight patients with surgical LV epicardial leads (SUR group). All ECGs were scanned and analyzed using digital callipers. Results:  Compared to the CS group, the TS group CRT was associated with a significant postpacing reduction in QTD (-45.2 ± 35.6 vs -4.3 ± 43.6 ms, P = 0.03) and T(peak-end) (-24.2 ± 22.1 vs 3.4 ± 26.7 ms, P = 0.02). There was a nonsignificant post-CRT reduction in both T(peak-end) D (-11.3 ± 31.0 vs 2.4 ± 28.9 ms, P = 0.27) and QTc (-50.0 ± 46.4 vs 4.4 ± 70.2 ms, P = 0.06) in the TS versus the CS group. In contrast, there were no differences between the SUR and CS groups in terms of the effect of CRT on these repolarization parameters. Conclusions:  CRT with (atrial transseptal) endocardial LV lead placement is associated with repolarization characteristics that are considered to be less arrhythmogenic than those generated by CS (epicardial) LV lead placement. Further work is needed to determine whether these changes translate to a reduction in proarrhythmia. (PACE 2011; 1-9).
Paul A Scott; Arthur M Yue; Edd Watts; Mehmood Zeb; Paul R Roberts; John M Morgan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-5-26
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  -     ISSN:  1540-8159     ISO Abbreviation:  -     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-5-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
©2011, The Authors. Journal compilation ©2011 Wiley Periodicals, Inc.
Wessex Cardiothoracic Unit, Southampton University Hospitals NHS Trust, Southampton, UK School of Medicine, University of Southampton, Southampton, UK.
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