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Related Experiment Videos

Asystole following left ventricular pacing.

Rebecca W Lai1, Kent J Volosin

  • 1University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA.

Pacing and Clinical Electrophysiology : PACE
|June 11, 2004
PubMed
Summary

Pacing the left ventricle during biventricular ICD implantation can cause asystole due to the Bezold-Jarisch reflex. This reflex involves C fiber stimulation, leading to a sudden drop in heart rate and blood pressure.

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Biventricular implantable cardioverter-defibrillator (ICD) implantation is a standard procedure for heart failure.
  • Epicardial lead placement in the left ventricle (LV) is sometimes necessary for optimal device function.
  • Coronary sinus (CS) lead placement is a common approach for LV pacing.

Observation:

  • During LV epicardial pacing via the coronary sinus during ICD implantation, a sudden onset of asystole was observed.
  • Asystole is defined as a complete cessation of electrical activity in the heart.

Findings:

  • The observed asystole is proposed to be a manifestation of the Bezold-Jarisch reflex.
  • This reflex is triggered by direct stimulation of cardiac C fibers.
  • The reflex results in a significant and rapid decrease in both heart rate and blood pressure.

Implications:

  • Understanding the Bezold-Jarisch reflex is crucial for managing potential complications during ICD procedures.
  • This finding highlights the importance of careful lead placement and monitoring during epicardial LV pacing.
  • Further research may explore strategies to mitigate or prevent this reflex during cardiac interventions.

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